7,193 results match your criteria Medical Care[Journal]


Costs and Trends of Emergency Department Utilization Pre-ACA and Post-ACA: Evidence From a Rural Georgia Hospital.

Med Care 2019 Apr 15. Epub 2019 Apr 15.

College of Allied Health Sciences, Augusta University.

Background: A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001114DOI Listing
April 2019
1 Read

Maryland's Global Hospital Budgets: Impacts on Medicare Cost and Utilization for the First 3 Years.

Med Care 2019 Apr 15. Epub 2019 Apr 15.

RTI International, Research Triangle Park, NC.

Background: Global budgets have been proposed as a way to control health care expenditures, but experience with them in the United States is limited. Global budgets for Maryland hospitals, the All-Payer Model, began in January 2014.

Objectives: To evaluate the effect of hospital global budgets on health care utilization and expenditures. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001118DOI Listing
April 2019
1 Read

Using Stakeholder Engagement to Overcome Barriers to Implementing Patient-reported Outcomes (PROs) in Cancer Care Delivery: Approaches From 3 Prospective Studies.

Med Care 2019 May;57 Suppl 5 Suppl 1:S92-S99

Department of Health Policy and Management.

Introduction: Patient-reported outcome (PRO) measures used during cancer care delivery improve communication about symptoms between patients and clinicians and reduce service utilization for uncontrolled symptoms. However, uptake of PROs in routine cancer care has been slow. In this paper, we describe stakeholder engagement activities used to overcome barriers to implementing PROs. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001103DOI Listing
May 2019
1 Read

Interpreting and Acting on the PRO Scores From the Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) eHealth System.

Med Care 2019 May;57 Suppl 5 Suppl 1:S85-S91

Ingham Institute for Applied Medical Research, Liverpool, NSW.

Introduction: Patient-reported Outcomes for Personalized Treatment and Care (PROMPT-Care) is the first eHealth system in Australia that is fully electronically integrated into hospital oncology information systems, enabling real-time, routine collection of patient-reported outcomes (PROs) to support and enable cancer patients to achieve and maintain improved health, well-being, and cancer outcomes. Five previously published papers detail the impetus for developing this eHealth system, its development, and testing of its acceptability and feasibility, the development of algorithms to standardize the cancer care pathways which underpin patient care, and the protocol for evaluating the efficacy of PROMPT-Care.

Methods: This manuscript provides "how-to" guidance to inform future system development, focusing on selecting relevant PROs and measuring them in cancer patients, score interpretation, and determining recommended care in response to scores which are above the predetermined threshold. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001094DOI Listing
May 2019
1 Read

A Decade in Review: Cancer Care Ontario's Approach to Symptom Assessment and Management.

Med Care 2019 May;57 Suppl 5 Suppl 1:S80-S84

Cancer Care Ontario, Toronto, ON.

Background: In 2007 Cancer Care Ontario (CCO) implemented standardized systematic symptom evaluation in all cancer patients in Ontario using the Edmonton Symptom Assessment System. The initial implementation did not include symptom management guidance and this limited the success of the implementation. Within a short time, the need for guidance on how to respond to symptoms became apparent. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001084DOI Listing
May 2019
1 Read

A Case Management System for Integrating Patient-reported Outcome Assessment in Clinical Practice: The Beacon Tool.

Med Care 2019 May;57 Suppl 5 Suppl 1:S73-S79

Department of Health Sciences Research.

Introduction: What if you could only ask one question of the patient during a clinic visit? Further, suppose the patient's biggest concern can pragmatically be incorporated into routine clinical care and clinical pathways that can address the patient's single biggest concern can be identified. If the principal concern can be dealt with efficiently at each visit through key stakeholder case management, positive outcomes should result. Therefore, motivated by the need for patient-centered health care visits, the Beacon electronic patient-reported outcomes (PRO) quality of life (QOL) tool was developed. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001095DOI Listing
May 2019
2 Reads

Engaging Patients and Clinicians in Online Reporting of Adverse Effects During Chemotherapy for Cancer: The eRAPID System (Electronic Patient Self-Reporting of Adverse Events: Patient Information and aDvice).

Med Care 2019 May;57 Suppl 5 Suppl 1:S59-S65

Section of Patient Centered Outcomes Research, St James' University Hospital, Leeds, United Kingdom.

Introduction: During cancer treatment the timely detection and management of adverse events is essential for patient safety and maintaining the quality of life. Electronic patient self-Reporting of Adverse events: Patient Information and aDvice (eRAPID) was devised to support oncology practice, by allowing patients to self-report symptoms online at home during and beyond cancer treatment. Fundamentally the eRAPID intervention delivers immediate severity-tailored feedback directly to patients to guide self-management strategies or hospital contact. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001085DOI Listing

Options for the Interpretation of and Recommendations for Acting on Different PROMs in Daily Clinical Practice Using KLIK.

Med Care 2019 May;57 Suppl 5 Suppl 1:S52-S58

Psychosocial Department, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam.

Introduction: This paper describes the different ways in which information is being fed back to health care providers (HCPs) using the Dutch evidence-based KLIK Patient-Reported Outcome Measures (PROMs) portal (www.hetklikt.nu). Read More

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http://dx.doi.org/10.1097/MLR.0000000000001061DOI Listing

Interpreting and Acting on PRO Results in Clinical Practice: Lessons Learned From the PatientViewpoint System and Beyond.

Med Care 2019 May;57 Suppl 5 Suppl 1:S46-S51

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins.

Introduction: We have used several methods to aid in the interpretation of patient-reported outcome (PRO) scores, and to suggest recommendations for acting on them, both within the PatientViewpoint system and in work done since.

Methods For Interpreting Pro Scores: For identifying possibly concerning change scores, PatientViewpoint uses questionnaires' minimally important differences or score worsening >½ SD. For poor scores in absolute terms, PatientViewpoint primarily uses distributions based on normative data (eg, worst quartile, >2 SD from the mean). Read More

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http://dx.doi.org/10.1097/MLR.0000000000001086DOI Listing
May 2019
1 Read

Can Methods Developed for Interpreting Group-level Patient-reported Outcome Data be Applied to Individual Patient Management?

Med Care 2019 May;57 Suppl 5 Suppl 1:S38-S45

Patient Centered Outcomes, Bethesda, MD.

Background: Patient-reported outcome (PRO) data may be used at 2 levels: to evaluate impacts of disease and treatment aggregated across individuals (group-level) and to screen/monitor individual patients to inform their management (individual-level). For PRO data to be useful at either level, we need to understand their clinical relevance.

Purpose: To provide clarity on whether and how methods historically developed to interpret group-based PRO research results might be applied in clinical settings to enable PRO data from individual patients to inform their clinical management and decision-making. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467500PMC

Turning Feed-forward and Feedback Processes on Patient-reported Data into Intelligent Action and Informed Decision-making: Case Studies and Principles.

Med Care 2019 May;57 Suppl 5 Suppl 1:S31-S37

Patient Reported Outcomes, Dartmouth Hitchcock Medical Center.

Introduction: The collection of patient-reported outcomes (PROs) in routine clinical practice provides opportunities to "feed-forward" the patient's perspective to his/her clinical team to inform planning and management. This data can also be aggregated to "feedback" population-level analytics that can inform treatment decision-making, predictive modeling, population-based care, and system-level quality improvement efforts.

Methods Aiding Interpretation And Acting On Results: Three case studies demonstrate a number of system-level features which aid effective PRO interpretation: (1) feed-forward and feedback information flows; (2) score interpretation aids; (3) cascading measurement; (4) registry-enabled learning health care systems; and (5) the maturational development of information systems. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001088DOI Listing
May 2019
1 Read

Applying PRO Reference Values to Communicate Clinically Relevant Information at the Point-of-care.

Med Care 2019 May;57 Suppl 5 Suppl 1:S24-S30

Optum Patient Insights, Johnston, RI.

Introduction: The inclusion of reference values for common patient-reported outcomes (PROs) measures in clinical care settings provides a clinically relevant context for an individual patient's PRO scores. PRO reference values are currently not reported in clinical care settings. This is a missed opportunity, as clinicians are familiar with the presence and interpretation of reference values, commonly provided alongside laboratory test results. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001113DOI Listing

A Rasch Measurement Theory Approach to Improve the Interpretation of Patient-reported Outcomes.

Med Care 2019 May;57 Suppl 5 Suppl 1:S18-S23

Modus Outcomes, Letchworth Garden City, United Kingdom.

Introduction: Interpretability is a key challenge for researchers, clinicians, and patients interested in using the output of patient-reported outcome (PRO) instruments. When rich and detailed meaning is required to assist individual patients to make treatment choices we propose that the item content of psychometric rating scales should be better leveraged to improve interpretability.

Methods: Modern psychometric methods such as Rasch measurement theory allow PRO users to map patient progress up or down a scale over time to item benchmarks. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001096DOI Listing
May 2019
1 Read

PRO-Bookmarking to Estimate Clinical Thresholds for Patient-reported Symptoms and Function.

Med Care 2019 May;57 Suppl 5 Suppl 1:S13-S17

Duke University School of Medicine, Durham, NC.

Introduction: PRO-Bookmarking is an alternative to traditional methods for deriving cut scores and applying qualitative modifiers to score ranges.

Methods: In PRO-Bookmarking, a working group of stakeholders identifies ranges of scores they judge to credibly define different levels of a patient-reported outcome (PRO). Subsets of items and responses, called "clinical vignettes," are woven into a narrative to represent different levels of the PRO. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001087DOI Listing

Interpreting Patient-reported Outcome Scores for Clinical Research and Practice: Definition, Determination, and Application of Cutpoints.

Med Care 2019 May;57 Suppl 5 Suppl 1:S8-S12

Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX.

Objectives: Cutpoints are specific numeric values used to create discrete categories for patient-reported outcome (PRO) items or scales. Cutpoints are widely used in both clinical research and practice. This article offers a definition for cutpoints, describes strategies for determining actionable cutpoints, and discusses considerations related to interpreting cutpoints in clinical applications. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001062DOI Listing
May 2019
1 Read

A PRO-cision Medicine Methods Toolkit to Address the Challenges of Personalizing Cancer Care Using Patient-Reported Outcomes: Introduction to the Supplement.

Med Care 2019 May;57 Suppl 5 Suppl 1:S1-S7

Johns Hopkins School of Medicine.

Patients are increasingly being asked to complete standardized, validated questionnaires with regard to their symptoms, functioning, and well-being [ie, patient-reported outcomes (PROs)] as part of routine care. These PROs can be used to inform patients' care and management, which we refer to as "PRO-cision Medicine." For PRO-cision Medicine to be most effective, clinicians and patients need to be able to understand what the PRO scores mean and how to act on the PRO results. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001089DOI Listing

Medicaid Expansion at Title X Clinics: Client Volume, Payer Mix, and Contraceptive Method Type.

Med Care 2019 Apr 9. Epub 2019 Apr 9.

School of Public Health, University of Maryland, College Park, MD.

Background: Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act's Medicaid expansion.

Objectives: To examine the impact of the Affordable Care Act's Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001120DOI Listing
April 2019
1 Read

A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes.

Med Care 2019 May;57(5):353-361

Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, Philadelphia, PA.

Background: The nurse work environment is theorized to influence the quality of nursing care, nurse job outcomes, and patient outcomes.

Objective: The aim of this meta-analysis was to evaluate quantitatively the association of the work environment with job and health outcomes.

Research Design: Relevant studies published through September 2018 were identified. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001109DOI Listing

Collaboration in Health Care and Social Service Networks for Older Adults: Association With Health Care Utilization Measures.

Med Care 2019 May;57(5):327-333

Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.

Background: Services targeting social determinants of health-such as income support, housing, and nutrition-have been shown to improve health outcomes and reduce health care costs for older adults. Nevertheless, evidence on the properties of effective collaborative networks across health care and social services sectors is limited.

Objectives: The main objectives of this study were to identify features of collaborative networks of health care and social services organizations associated with avoidable health care use and spending for older adults. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001097DOI Listing

Changes in Caregiver Health in the Years Surrounding the Birth of a Child With Health Problems: Administrative Data From British Columbia.

Med Care 2019 May;57(5):369-376

School of Epidemiology & Public Health, University of Ottawa.

Background: Caregivers of children with health problems (CHPs; usually mothers) experience more physical and psychological health problems than those of children without health problems (non-CHPs). Primarily cross-sectional and survey-driven, this literature has not yet explored whether these health differences existed before the birth of the CHPs, or are exacerbated postbirth.

Methods: Using linked administrative health data on all mother-child dyads for children born in the year 2000 in British Columbia, Canada, we examined maternal health before, during, and after the birth of CHPs, and compared it between mothers of CHPs and non-CHPs with piecewise growth curve modeling. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001098DOI Listing

US Physicians' Work Motivation and Their Occupational Health: A National Survey of Practicing Physicians.

Med Care 2019 May;57(5):334-340

Ethics Group, American Medical Association, Chicago, IL.

Background: Poor occupational health among physicians poses a serious risk both to physicians themselves and the patients under their care. Prior research has found that occupational health among nonphysicians is associated with both degree and type of work motivation.

Objective: The main purpose of this article was to assess the association between physician work motivation and their occupational health. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001101DOI Listing
May 2019
3 Reads

Does Primary Care Provider Supply Influence Medicaid Acceptability?

Med Care 2019 May;57(5):348-352

Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, IL.

Background: Following the Affordable Care Act's Medicaid expansions, access to care improved through elevated coverage rates among the low-income population. In Michigan, a major factor contributing to improved access among low-income patients was increased Medicaid acceptance in primary care settings.

Objectives: Prior evidence shows substantial geographic variation preacceptance and postacceptance of Medicaid. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001110DOI Listing
May 2019
3 Reads

The Association of Nurse Practitioner Scope-of-Practice Laws With Emergency Department Use: Evidence From Medicaid Expansion.

Med Care 2019 May;57(5):362-368

Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman, MT.

Background: Overuse and inappropriate use of emergency departments (EDs) remains an important issue in health policy. After implementation of Medicaid expansion, many states experienced an increase in ED use, but the magnitude varied. Differential access to primary care might explain such variation. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001100DOI Listing
May 2019
4 Reads

Relationship Between State Policy and Anesthesia Provider Supply in Rural Communities.

Med Care 2019 May;57(5):341-347

RAND Corporation, Pittsburgh, PA.

Background: There is a significant geographic variation in anesthesia provider supply. Lower supply in rural communities raises concerns about access to procedures that require anesthesia in rural areas. State policies related to certified registered nurse anesthetist (CRNA) practice may help to alleviate rural supply concerns. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001106DOI Listing
May 2019
2 Reads

Clinical Scenarios for Which Spinal Mobilization and Manipulation Are Considered by an Expert Panel to be Inappropriate (and Appropriate) for Patients With Chronic Low Back Pain.

Med Care 2019 May;57(5):391-398

RAND Corporation, Santa Monica, CA.

Background: Spinal mobilization and manipulation are 2 therapies found to be generally safe and effective for chronic low back pain (CLBP). However, the question remains whether they are appropriate for all CLBP patients.

Research Design: An expert panel used a well-validated approach, including an evidence synthesis and clinical acumen, to develop and then rate the appropriateness of the use of spinal mobilization and manipulation across an exhaustive list of clinical scenarios which could present for CLBP. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459705PMC
May 2019
3 Reads

Retooling of Paper-based Outcome Measures to Electronic Format: Comparison of the NY State Public Risk Model and EHR-derived Risk Models for CABG Mortality.

Med Care 2019 May;57(5):377-384

Department of Quality Measurement, The Joint Commission, Oakbrook Terrace, IL.

Background: Risk adjustment is critical in the comparison of quality of care and health care outcomes for providers. Electronic health records (EHRs) have the potential to eliminate the need for costly and time-consuming manual data abstraction of patient outcomes and risk factors necessary for risk adjustment.

Methods: Leading EHR vendors and hospital focus groups were asked to review risk factors in the New York State (NYS) coronary artery bypass graft (CABG) surgery statistical models for mortality and readmission and assess feasibility of EHR data capture. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001104DOI Listing

Trends and Racial Differences in First Hospitalization for Stroke and 30-Day Mortality in the US Medicare Population From 1988 to 2013.

Med Care 2019 Apr;57(4):262-269

Division of Hospital Medicine, the University of California, San Francisco, San Francisco, CA.

Purpose: The main purpose of this study was to determine whether there were temporal differences in the rates of first stroke hospitalizations and 30-day mortality after stroke between black and white Medicare enrollees.

Methods: We used a 20% sample of Medicare beneficiaries aged 65 years or older and described the annual rate of first hospitalization for ischemic and hemorrhagic strokes from years 1988 to 2013, as well as 30-day mortality after stroke hospitalization. We used linear tests of trend to determine whether stroke rates changed over time, and tested the interaction term between race and year to determine whether trends differed by race. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419736PMC
April 2019
1 Read

Revenue Losses to State and Federal Government From Opioid-related Employment Reductions.

Med Care 2019 Mar 5. Epub 2019 Mar 5.

Department of Health Policy and Administration, Pennsylvania State University, University Park.

Objective: The main purpose of this study was to estimate the tax revenue lost by state and federal governments as a result of adverse labor market outcomes attributable to opioid misuse.

Methods: We pair existing, plausibly causal estimates of the effect of opioid misuse on the decline in the labor force from 2000 to 2016 with a variety of data sources to compute tax revenues lost by state and federal governments using the online TAXSIM calculator.

Results: We find that between 2000 and 2016, opioid misuse cost state governments $11. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001107DOI Listing

Factors Associated With Accuracy of Self-Assessment Compared With Tested Non-English Language Proficiency Among Primary Care Providers.

Med Care 2019 May;57(5):385-390

Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service.

Background: There are no accepted best practices for clinicians to report their non-English language (NEL) fluencies. Language discordance between patients with limited English proficiency and their clinicians may contribute to suboptimal quality of care.

Objectives: To compare self-assessed clinician NEL proficiency with a validated oral language proficiency test. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459717PMC
May 2019
2 Reads
3.232 Impact Factor

Collaborative Networks of Health Systems and Social Service Agencies: Clinical Public Health in Action.

Authors:
Ronnie D Horner

Med Care 2019 May;57(5):325-326

Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC.

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http://dx.doi.org/10.1097/MLR.0000000000001102DOI Listing

Does Transfer to Intensive Care Units Reduce Mortality? A Comparison of an Instrumental Variables Design to Risk Adjustment.

Med Care 2019 Feb 27. Epub 2019 Feb 27.

Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.

Background: Instrumental variable (IV) analysis can estimate treatment effects in the presence of residual or unmeasured confounding. In settings wherein measures of baseline risk severity are unavailable, IV designs are, therefore, particularly appealing, but, where established measures of risk severity are available, it is unclear whether IV methods are preferable.

Objective: We compared regression with an IV design to estimate the effect of intensive care unit (ICU) transfer on mortality in a study with well-established measures of risk severity. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001093DOI Listing
February 2019
1 Read

The Impact of Pharmacy-specific Predictors on the Performance of 30-Day Readmission Risk Prediction Models.

Med Care 2019 Apr;57(4):295-299

Division of Research, Kaiser Permanente Northern California, Oakland, CA.

Research Objective: Pharmacists are an expensive and limited resource in the hospital and outpatient setting. A pharmacist can spend up to 25% of their day planning. Time spent planning is time not spent delivering an intervention. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417963PMC
April 2019
12 Reads

ACO Affiliated Hospitals Increase Implementation of Care Coordination Strategies.

Med Care 2019 Apr;57(4):300-304

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

Background: Hospitals affiliated with Accountable Care Organizations (ACOs) may have a greater capacity to collaborate with providers across the care continuum to coordinate care, due to formal risk sharing and payment arrangements. However, little is known about the extent to which ACO affiliated hospitals implement care coordination strategies.

Objectives: To compare the implementation of care coordination strategies between ACO affiliated hospitals (n=269) and unaffiliated hospitals (n=502) and examine whether the implementation of care coordination strategies varies by hospital payment model types. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417934PMC

Contribution of HCAHPS Specific Care Experiences to Global Ratings Varies Across 7 Countries: What Can be Learned for Reporting These Global Ratings?

Med Care 2019 Feb 21. Epub 2019 Feb 21.

Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.

Background: Given the increased international interest in improvement strategies for patient experiences with care, it is important to understand whether the same specific care experiences affect global ratings across countries. Moreover, reporting of these global ratings currently substantially varies in both research and public reporting.

Objectives: The objectives of this study were to examine the differential magnitude of associations between Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) specific care experiences and global ratings, and to explore implications for reporting these global ratings. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001077DOI Listing
February 2019

Racial Differences in Insurance Stability After Health Insurance Reform.

Med Care 2019 04;57(4):256-261

Boston University School of Medicine.

Background: One of the potential benefits of insurance reform is greater stability of insurance and reduced coverage disparities by race and ethnicity.

Objectives: We examined the temporal trends in insurance coverage by racial/ethnic group before and after Massachusetts Insurance Reform by abstracting records across 2 urban safety net hospital systems.

Research Design: We examined adjusted odds of being uninsured and incident rate ratios of gaining and losing insurance over time by race and ethnicity. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001078DOI Listing
April 2019
3 Reads

Ascertainment of Aspirin Exposure Using Structured and Unstructured Large-scale Electronic Health Record Data.

Med Care 2019 Feb 21. Epub 2019 Feb 21.

VA San Diego Healthcare System.

Background: Aspirin impacts risk for important outcomes such as cancer, cardiovascular disease, and gastrointestinal bleeding. However, ascertaining exposure to medications available both by prescription and over-the-counter such as aspirin for research and quality improvement purposes is a challenge.

Objectives: Develop and validate a strategy for ascertaining aspirin exposure, utilizing a combination of structured and unstructured data. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001065DOI Listing
February 2019
1 Read

Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services.

Med Care 2019 Apr;57(4):245-255

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston.

Background: Decades-long efforts to require parity between behavioral and physical health insurance coverage culminated in the comprehensive federal Mental Health Parity and Addiction Equity Act.

Objectives: To determine the association between federal parity and changes in mental health care utilization and spending, particularly among high utilizers.

Research Design: Difference-in-differences analyses compared changes before and after exposure to federal parity versus a comparison group. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6423539PMC

Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus: The Veteran Birth Cohort.

Med Care 2019 Apr;57(4):279-285

Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, CT.

Background: Veterans with hepatitis C virus (HCV) infection may face geographic obstacles to obtaining treatment.

Objective: We studied the influence of region and rural versus urban residence on receipt of direct-acting antiretroviral (DAA) medications for HCV.

Subjects: Veterans receiving care within Veterans Affairs Healthcare System born between 1945 and 1965. Read More

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http://dx.doi.org/10.1097/MLR.0000000000001071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436819PMC
April 2019
6 Reads

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 Apr;57(4):270-278

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
April 2019
1 Read
3.232 Impact Factor

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 Apr;57(4):286-294

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417959PMC

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

Med Care 2019 Apr;57(4):305-311

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417956PMC
April 2019
3.232 Impact Factor

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6410972PMC
March 2019
1 Read

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

Med Care 2019 04;57(4):318-324

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417929PMC
April 2019
1 Read

Trends in Hospital Utilization After Medicaid Expansion.

Med Care 2019 Apr;57(4):312-317

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417939PMC

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
8 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