918 results match your criteria Medical Care Research and Review MCRR[Journal]


Development and Psychometric Analysis of the Revised Patient Perceptions of Integrated Care Survey.

Med Care Res Rev 2019 Apr 15:1077558719842951. Epub 2019 Apr 15.

3 Harvard Medical School, Boston, MA, USA.

This article describes the development and psychometric testing of the Patient Perceptions of Integrated Care (PPIC 2.1) survey, which we administered to 12,364 Medicare beneficiaries who received treatment from 150 randomly selected physician organizations, receiving 3,067 responses (26%). Psychometric analyses, performed using two methods to adjust for respondent inherent optimism (as a measure of response tendency), supported a 6-factor, 22-item model with excellent fit. Read More

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http://dx.doi.org/10.1177/1077558719842951DOI Listing

Quality Management Strategies in Medicaid Managed Care: Perspectives From Medicaid, Plans, and Providers.

Med Care Res Rev 2019 Apr 4:1077558719841157. Epub 2019 Apr 4.

1 Brown University, Providence, RI, USA.

Medicaid managed care allows Medicaid beneficiaries to receive services through contractual relationships between managed care organizations and state Medicaid offices. Medicaid offices monitor quality of care, and many states encourage or require plans to adopt quality management practices. This research examines quality management in Medicaid managed care from the perspectives of Medicaid officials, managed care plan representatives, and providers through 25 qualitative interviews in one Northeastern state. Read More

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http://dx.doi.org/10.1177/1077558719841157DOI Listing
April 2019
1 Read

Stages of Change: Moving Community Pharmacies From a Drug Dispensing to Population Health Management Model.

Med Care Res Rev 2019 Apr 3:1077558719841159. Epub 2019 Apr 3.

1 University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Given their clinical training and accessibility, community pharmacists are well positioned to support primary care, especially in providing medication management services. There is limited evidence, however, on implementation of community pharmacist-led services in coordination with other health care providers. The aim of this study was to examine the implementation process of community pharmacies in North Carolina participating in a Medicaid population health management intervention. Read More

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http://dx.doi.org/10.1177/1077558719841159DOI Listing

When the Evidence Basis Breeds Controversies: Exploring the Value Profile of Robotic Surgery Beyond the Early Introduction Phase.

Med Care Res Rev 2019 Mar 22:1077558719832797. Epub 2019 Mar 22.

1 Maastricht University, Maastricht, The Netherlands.

This article investigates qualitatively the value profile of the da Vinci® surgical robot after almost two decades of extensive clinical use and research. We aimed to understand whether the swiftly growing body of published studies on robotic prostate surgery can now, that is, beyond an early stage, guide decisions on the acquisition, procurement, and public provision of this innovation. We explored both published studies and the perspectives of diverse stakeholders in the Netherlands. Read More

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http://dx.doi.org/10.1177/1077558719832797DOI Listing

Home Health Utilization in Assisted Living Settings.

Med Care Res Rev 2019 Mar 19:1077558719835049. Epub 2019 Mar 19.

1 Brown University, Providence, RI, USA.

Home health agencies (HHAs) are one of the most commonly used third-party providers in the assisted living (AL) setting. One way ALs may be potentially able to meet the needs of their residents despite increased impairment is through supplementing the services offered with those delivered by HHAs. We explore the growth in the delivery of HHA services to Medicare beneficiaries in AL compared with other home settings between 2012 and 2014. Read More

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http://dx.doi.org/10.1177/1077558719835049DOI Listing

Weighing the Effects of Vertical Integration Versus Market Concentration on Hospital Quality.

Med Care Res Rev 2019 Feb 9:1077558719828938. Epub 2019 Feb 9.

1 Rice University, Houston, TX, USA.

Provider organizations are increasing in complexity, as hospitals acquire physician practices and physician organizations grow in size. At the same time, hospitals are merging with each other to improve bargaining power with insurers. We analyze 29 quality measures reported to the Center for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015 to test whether vertical integration between hospitals and physicians or increases in hospital market concentration influence patient outcomes. Read More

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http://dx.doi.org/10.1177/1077558719828938DOI Listing
February 2019

Provider Perspectives of Medication Complexity in Home Health Care: A Qualitative Secondary Data Analysis.

Med Care Res Rev 2019 Feb 7:1077558719828942. Epub 2019 Feb 7.

1 New York University, New York, NY, USA.

A primary service provided by home care is medication management. Issues with medication management at home place older adults at high risk for hospital admission, readmission, and adverse events. This study sought to understand medication management challenges from the home care provider perspective. Read More

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http://dx.doi.org/10.1177/1077558719828942DOI Listing
February 2019
2 Reads

Selection Incentives for Health Insurers in the Presence of Sophisticated Risk Adjustment.

Med Care Res Rev 2019 Feb 1:1077558719825982. Epub 2019 Feb 1.

1 Erasmus University Rotterdam, Rotterdam, Netherlands.

This article analyzes selection incentives for insurers in the Dutch basic health insurance market, which operates with community-rated premiums and sophisticated risk adjustment. Selection incentives result from the interplay of three market characteristics: possible actions by insurers, consumer response to these actions, and predictable variation in profitability of insurance contracts. After a qualitative analysis of the first two characteristics our primary objective is to identify the third. Read More

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http://dx.doi.org/10.1177/1077558719825982DOI Listing
February 2019

Landscape of Health Systems in the United States.

Med Care Res Rev 2019 Jan 23:1077558718823130. Epub 2019 Jan 23.

3 Mathematica Policy Research, Washington, DC, USA.

Despite the prevalence of vertical integration, data and research focused on identifying and describing health systems are sparse. Until recently, we lacked an enumeration of health systems and an understanding of how systems vary by key structural attributes. To fill this gap, the Agency for Healthcare Research and Quality developed the Compendium of U. Read More

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http://dx.doi.org/10.1177/1077558718823130DOI Listing
January 2019
5 Reads

Evaluating Hospital Readmissions for Persons With Serious and Complex Illness: A Competing Risks Approach.

Med Care Res Rev 2019 Jan 18:1077558718823919. Epub 2019 Jan 18.

4 VCU Medical Center, Richmond, VA, USA.

Hospital readmission rate is a ubiquitous measure of efficiency and quality. Individuals with life-limiting illnesses account heavily for admissions but evaluation is complicated by high-mortality rates. We report a retrospective cohort study examining the association between palliative care (PC) and readmissions while controlling for postdischarge mortality with a competing risks approach. Read More

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http://dx.doi.org/10.1177/1077558718823919DOI Listing
January 2019
11 Reads

Medicaid Accountable Care Organizations and Childbirth Outcomes.

Med Care Res Rev 2019 Jan 7:1077558718823132. Epub 2019 Jan 7.

2 Agency for Healthcare Research and Quality, Rockville, MD, USA.

Some states have adopted Accountable Care Organization (ACO) models to transform their Medicaid programs, but little is known about their impact on health care outcomes and costs. Medicaid ACOs are uniquely positioned to improve childbirth outcomes because of the number of births covered by Medicaid. Using Healthcare Cost and Utilization Project hospital data, we examined the relationship between ACO adoption and (a) neonatal and maternal outcomes, and (b) cost per birth. Read More

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http://dx.doi.org/10.1177/1077558718823132DOI Listing
January 2019

Burden Associated With Selecting and Using Health Insurance to Manage Care Costs: Results of a Qualitative Study of Nonelderly Cancer Survivors.

Med Care Res Rev 2018 Dec 20:1077558718820232. Epub 2018 Dec 20.

1 Washington University School of Medicine, St. Louis, MO, USA.

This qualitative study explored cancer survivors' experiences selecting and using health insurance and anticipating out-of-pocket care costs. Thirty individuals participated in semistructured interviews. On average, participants were 54 years ( SD ± 8. Read More

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http://dx.doi.org/10.1177/1077558718820232DOI Listing
December 2018

Hospitals Strengthened Relationships With Close Partners After Joining Accountable Care Organizations.

Med Care Res Rev 2018 Dec 13:1077558718818336. Epub 2018 Dec 13.

3 University of Michigan, Ann Arbor, MI, USA.

The strategies that hospitals participating in Medicare Accountable Care Organizations (ACOs) use to achieve quality and cost containment goals are poorly understood. One possibility is that participating hospitals could try to influence where their patients receive care. To test this hypothesis, we examined whether a hospital's participation in a Medicare ACO was associated with changes in its patterns of patient sharing with other hospitals. Read More

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http://journals.sagepub.com/doi/10.1177/1077558718818336
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http://dx.doi.org/10.1177/1077558718818336DOI Listing
December 2018
1 Read

Are Changes in Medical Group Practice Characteristics Over Time Associated With Medicare Spending and Quality of Care?

Med Care Res Rev 2018 Nov 22:1077558718812939. Epub 2018 Nov 22.

4 UC-Berkeley School of Public Health, Berkeley, CA, USA.

Physician practices have been growing in size, and becoming more commonly owned by hospitals, over time. We use survey data on physician practices surveyed at two points in time, linked to Medicare claims data, to investigate whether changes in practice size or ownership are associated with changes in the use of care management, health information technology (HIT), or quality improvement processes. We find that practice growth and becoming hospital-owned are associated with adoption of more quality improvement processes, but not with care management or HIT. Read More

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http://journals.sagepub.com/doi/10.1177/1077558718812939
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http://dx.doi.org/10.1177/1077558718812939DOI Listing
November 2018
15 Reads

Frontline Workers' Career Pathways: A Detailed Look at Washington State's Medical Assistant Workforce.

Med Care Res Rev 2018 Nov 17:1077558718812950. Epub 2018 Nov 17.

1 Center for Health Workforce Studies, University of Washington, Seattle, WA, USA.

Medical assistants (MAs) are a rapidly growing and increasingly important workforce. High MA turnover, however, is common and employers report applicants frequently do not meet their needs. We collected survey responses from a representative sample of 3,355 of Washington's MAs with certified status (MA-Cs) to understand their demographic, education, and employment backgrounds; job satisfaction; and career plans. Read More

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http://dx.doi.org/10.1177/1077558718812950DOI Listing
November 2018
15 Reads

Impact of Health Plan Deductibles and Health Insurance Marketplace Enrollment on Health Care Experiences.

Med Care Res Rev 2018 Nov 7:1077558718810129. Epub 2018 Nov 7.

1 Florida International University, Miami, FL, USA.

High-deductible health plans (HDHPs) have become increasingly prevalent among employer-sponsored health plans and plans offered through the Health Insurance Marketplace in the United States. This study examined the impact of deductible levels on health care experiences in terms of care access, affordability, routine checkup, out-of-pocket cost, and satisfaction using data from the Health Reform Monitoring Survey. The study also tested whether the experiences of Marketplace enrollees differed from off-Marketplace individuals, controlling for deductible levels. Read More

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http://journals.sagepub.com/doi/10.1177/1077558718810129
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http://dx.doi.org/10.1177/1077558718810129DOI Listing
November 2018
16 Reads

Do Medicare Advantage Rebates Reduce Enrollees' Out-of-Pocket Spending?

Med Care Res Rev 2018 Nov 1:1077558718807847. Epub 2018 Nov 1.

1 Johns Hopkins University, Baltimore, MD, USA.

The majority of Medicare Advantage (MA) plans receive payments that exceed their costs of providing basic Medicare benefits. There is controversy about whether these payments are passed on to the enrollees as supplemental benefits or are retained by plans. We used survey data on MA beneficiaries' actual out-of-pocket (OOP) spending linked to MA payment information to test whether higher plan payments and rebates lowered enrollee OOP spending. Read More

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http://dx.doi.org/10.1177/1077558718807847DOI Listing
November 2018
3 Reads

Association of Patient Acuity and Missed Nursing Care in U.S. Neonatal Intensive Care Units.

Med Care Res Rev 2018 Oct 26:1077558718806743. Epub 2018 Oct 26.

5 Rutgers School of Public Health, New Brunswick, NJ, USA.

The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. Read More

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http://journals.sagepub.com/doi/10.1177/1077558718806743
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http://dx.doi.org/10.1177/1077558718806743DOI Listing
October 2018
11 Reads

The Effect of the Affordable Care Act Medicaid Expansion on Disparities in Access to Care and Health Status.

Med Care Res Rev 2018 Oct 26:1077558718808709. Epub 2018 Oct 26.

1 University of Massachusetts Boston, Boston, MA, USA.

Before the Affordable Care Act Medicaid expansion, nonelderly childless adults were not generally eligible for Medicaid regardless of their income, and Hispanics had much higher uninsured rates than other racial/ethnic subgroups. We estimated difference-in-differences models on Behavioral Risk Factor Surveillance data (2011-2016) to estimate the impacts of Medicaid expansion on racial/ethnic disparities in insurance coverage, access to care, and health status in this vulnerable subpopulation. Uninsured rates among all poor childless adults declined by roughly 9 percentage points more in states that expanded Medicaid. Read More

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http://dx.doi.org/10.1177/1077558718808709DOI Listing
October 2018

The Medicare Part D Coverage Gap, Prescription Use, and Expenditures.

Authors:
Aig Unuigbe

Med Care Res Rev 2018 Oct 18:1077558718806437. Epub 2018 Oct 18.

1 University of West Florida, Pensacola, FL, USA.

The Affordable Care Act has put in place policies to gradually close the Medicare Part D coverage gap (donut hole). I examine the effect of this gradual closure on total and out-of-pocket prescription drug expenditures, as well as the number of prescriptions filled. The analysis shows a general increase in prescription use. Read More

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http://dx.doi.org/10.1177/1077558718806437DOI Listing
October 2018
14 Reads

Educational Attainment and Perceived Need for Urgent Care.

Med Care Res Rev 2018 Oct 8:1077558718804748. Epub 2018 Oct 8.

5 RAND Corporation, Santa Monica, CA, USA.

While lower educational attainment is associated with worse health status, education may also affect one's ability to identify need for urgent care. Using data from the 2010 Medicare CAHPS survey, we estimated multivariate logistic models to test the relationship between self-reported educational attainment and the perceived need for urgent care, controlling for health status and other factors. As expected, lower educational attainment was associated with greater reported need for urgent care in bivariate analyses because of poorer health. Read More

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http://dx.doi.org/10.1177/1077558718804748DOI Listing
October 2018
5 Reads

A Rigorous Approach to Large-Scale Elicitation and Analysis of Patient Narratives.

Med Care Res Rev 2018 Oct 6:1077558718803859. Epub 2018 Oct 6.

4 RAND, Pittsburgh, PA, USA.

Patient narratives have emerged as promising vehicles for making health care more responsive by helping clinicians to better understand their patients' expectations, perceptions, or concerns and encouraging consumers to engage with information about quality. A growing number of websites incorporate patients' comments. But existing comments have fragmentary content, fail to represent less vocal patients, and can be manipulated to "manage" providers' reputations. Read More

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http://dx.doi.org/10.1177/1077558718803859DOI Listing
October 2018

Shifting From Passive Quality Reporting to Active Nudging to Influence Consumer Choice of Health Plan.

Med Care Res Rev 2018 Sep 26:1077558718798534. Epub 2018 Sep 26.

3 RAND Corporation, Santa Monica, CA, USA.

Comparative quality information on health plan and provider performance is increasingly available in the form of quality report cards, but consumers rarely make use of these passively provided decision support tools. In 2012-2013, the Centers for Medicare & Medicaid Services (CMS) initiated quality-based nudges designed to encourage beneficiaries to move into higher quality Medicare Advantage (MA) plans. We assess the impacts of CMS' targeted quality-based nudges with longitudinal analysis of 2009-2014 MA plan enrollment trends. Read More

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http://dx.doi.org/10.1177/1077558718798534DOI Listing
September 2018
3 Reads

Does a Reduction in Readmissions Result in Net Savings for Most Hospitals? An Examination of Medicare's Hospital Readmissions Reduction Program.

Med Care Res Rev 2018 Aug 24:1077558718795745. Epub 2018 Aug 24.

1 University of Michigan School of Nursing, Ann Arbor, MI, USA.

This study aimed (1) to estimate the impact of an incremental reduction in excess readmissions on a hospital's Medicare reimbursement revenue, for hospitals subject to penalties under the Medicare's Hospital Readmissions Reduction Program and (2) to evaluate the economic case for an investment in a readmission reduction program. For 2,465 hospitals with excess readmissions in the Fiscal Year 2016 Hospital Compare data set, we (1) used the Hospital Readmissions Reduction Program statute to estimate hospital-specific Medicare reimbursement gains per an avoided readmission and (2) carried out a pro forma analysis of investment in a broad-scale readmission reduction program under conservative assumptions regarding program effectiveness and using program costs from earlier studies. For an average hospital, avoiding one excess readmission would result in reimbursement gains of $10,000 to $58,000 for Medicare discharges. Read More

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http://dx.doi.org/10.1177/1077558718795745DOI Listing
August 2018
2 Reads
2.620 Impact Factor

The Financial Impact of an Avoided Readmission for Teaching and Safety-Net Hospitals Under Medicare's Hospital Readmission Reduction Program.

Med Care Res Rev 2018 Aug 24:1077558718795733. Epub 2018 Aug 24.

1 University of Michigan School of Nursing, Ann Arbor, USA.

We examined the financial incentives to avoid readmissions under Medicare's Hospital Readmission Reduction Program for safety-net hospitals (SNHs) and teaching hospitals (THs) compared with other hospitals. Using Medicare's FY2016 Hospital Compare and readmissions data for 2,465 hospitals, we tested for differential revenue gains for SNHs ( n = 658) relative to non-SNHs ( n = 1,807), and for major ( n = 231) and minor ( n = 591) THs relative to non-THs ( n = 1,643). We examined hospital-level factors predicting differences in revenue gains by hospital type. Read More

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http://dx.doi.org/10.1177/1077558718795733DOI Listing
August 2018
18 Reads
2.620 Impact Factor

Reference-Based Benefits for Colonoscopy and Arthroscopy: Large Differences in Patient Payments Across Procedures but Similar Behavioral Responses.

Med Care Res Rev 2018 Aug 13:1077558718793325. Epub 2018 Aug 13.

1 University of California, Berkeley, Berkeley, CA, USA.

This study examines how reference-based benefits (RBB) affect patient out-of-pocket payments across outpatient procedures. The California Public Employees' Retirement System (CalPERS) implemented RBB asymmetrically for outpatient procedures in 2012, only applying RBB to outpatient procedures performed in a hospital outpatient department (HOPD), and not applying RBB to outpatient procedures performed in a lower cost ambulatory surgery center. Using claims data (2009-2013) on arthroscopy and colonoscopy services, we found that for colonoscopy, CalPERS patients paid an average of 63. Read More

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http://dx.doi.org/10.1177/1077558718793325DOI Listing

Projected Contributions of Nurse Practitioners and Physicians Assistants to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas.

Med Care Res Rev 2018 Aug 9:1077558718793070. Epub 2018 Aug 9.

1 WWAMI Rural Health Research Center, University of Washington School of Medicine, Seattle, WA, USA.

The United States is experiencing an opioid use disorder epidemic. The Comprehensive Addiction and Recovery Act allows nurse practitioners (NPs) and physician assistants (PAs) to obtain a Drug Enforcement Administration waiver to prescribe medication-assisted treatment (MAT) for opioid use disorder. This study projected the potential increase in MAT availability provided by NPs and PAs for rural patients. Read More

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http://dx.doi.org/10.1177/1077558718793070DOI Listing
August 2018
1 Read

Consumer Numeracy and Insurance Design Decisions: An Examination of Inflation Protection Take-Up Among Private Long-Term Care Insurance Policy Holders.

Med Care Res Rev 2018 Jul 1:1077558718787742. Epub 2018 Jul 1.

1 Harvard Medical School, Boston, MA, USA.

Given the rising cost of long-term care (LTC) services, the selection of a private long-term care insurance (LTCi) policy with inflation protection has critical implications for the ability of this coverage to protect against potentially catastrophic LTC expenses. This study examines the effect of consumers' numeric abilities on the decision to add inflation protection to private LTCi policies. Over 40% of current LTCi policies lack inflation protection. Read More

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http://dx.doi.org/10.1177/1077558718787742DOI Listing

Does Risk Adjustment Reduce Vaccination in the Elderly? Evidence From Medicare Advantage.

Med Care Res Rev 2018 Jul 1:1077558718785559. Epub 2018 Jul 1.

2 University of Virginia, Charlottesville, VA, USA.

To combat risk selection, it is becoming increasingly common for payments to insurers (and providers) to adjust for patients' chronic conditions. A possible unintended negative consequence is to reduce insurers' (and providers') incentives to prevent chronic conditions. This study examined the effect of Medicare's risk adjustment for payments to Medicare Advantage plans, first introduced in 2004, on pneumonia and influenza vaccination for the elderly. Read More

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http://dx.doi.org/10.1177/1077558718785559DOI Listing
July 2018
19 Reads

Accountable Care Organizations and Post-Acute Care: A Focus on Preferred SNF Networks.

Med Care Res Rev 2018 Jul 1:1077558718781117. Epub 2018 Jul 1.

1 The Dartmouth Institute, Lebanon, NH, USA.

Due to high magnitude and variation in spending on post-acute care, accountable care organizations (ACOs) are focusing on transforming management of hospital discharge through relationships with preferred skilled nursing facilities (SNFs). Using a mixed-methods design, we examined survey data from 366 respondents to the National Survey of ACOs along with 16 semi-structured interviews with ACOs who performed well on cost and quality measures. Survey data revealed that over half of ACOs had no formal relationship with SNFs; however, the majority of ACO interviewees had formed preferred SNF networks. Read More

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http://dx.doi.org/10.1177/1077558718781117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312742PMC
July 2018
1 Read

The Privatization of Public Hospitals: Its Impact on Financial Performance.

Med Care Res Rev 2018 Jun 1:1077558718781606. Epub 2018 Jun 1.

2 University of Alabama at Birmingham, Birmingham, AL, USA.

This study examined the effects of public hospitals' privatization on financial performance. We used a sample of nonfederal acute care public hospitals from 1997 to 2013, averaging 434 hospitals per year. Privatization was defined as conversion from public status to either private not-for-profit (NFP) or private for-profit (FP) status. Read More

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http://dx.doi.org/10.1177/1077558718781606DOI Listing
June 2018
1 Read

Prices for Physicians' Services in Medicare Advantage and Commercial Plans.

Authors:
Daria M Pelech

Med Care Res Rev 2018 Jun 1:1077558718780604. Epub 2018 Jun 1.

1 Congressional Budget Office, Washington, DC, USA.

The prices that insurers pay physicians ultimately affect beneficiaries' health insurance premiums. Using 2014 claims data from three major insurers, we analyzed the prices insurers paid in their Medicare Advantage (MA) and commercial plans for 20 physician services, in and out of network, and compared those prices with estimated amounts that Medicare's fee-for-service (FFS) program would pay for the same service. MA prices paid by those insurers were close to Medicare FFS prices, varied minimally, and were similar in and out of network. Read More

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http://dx.doi.org/10.1177/1077558718780604DOI Listing
June 2018
1 Read

Cost-Effective Adjustments to Nursing Home Staffing to Improve Quality.

Med Care Res Rev 2018 Jun 1:1077558718778081. Epub 2018 Jun 1.

1 Miami University, Oxford, OH, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718778081DOI Listing

A Review of Mental Health and Mental Health Care Disparities Research: 2011-2014.

Med Care Res Rev 2018 Jun 1:1077558718780592. Epub 2018 Jun 1.

1 Cambridge Health Alliance, Cambridge, MA, USA.

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. Read More

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http://journals.sagepub.com/doi/10.1177/1077558718780592
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http://dx.doi.org/10.1177/1077558718780592DOI Listing
June 2018
17 Reads

Community Efforts to Reduce Racial and Ethnic Health Disparities: Challenges and Facilitators Identified by 16 Multistakeholder Alliances.

Med Care Res Rev 2018 May 1:1077558718776051. Epub 2018 May 1.

1 Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

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. Three themes highlight challenges related to collecting local data on racial and ethnic health disparities and transitioning from data collection to action. Read More

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http://dx.doi.org/10.1177/1077558718776051DOI Listing
May 2018
3 Reads

Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health.

Med Care Res Rev 2018 May 1:1077558718769481. Epub 2018 May 1.

1 Hennepin Healthcare, Minneapolis, MN, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718769481DOI Listing
May 2018
4 Reads

Changes in Quality of Life Among Enrollees in Hennepin Health: A Medicaid Expansion ACO.

Med Care Res Rev 2018 May 1:1077558718769457. Epub 2018 May 1.

1 Hennepin Healthcare, Minneapolis, MN, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718769457DOI Listing
May 2018
9 Reads

Why Do So Few Consumers Use Health Care Quality Report Cards? A Framework for Understanding the Limited Consumer Impact of Comparative Quality Information.

Med Care Res Rev 2018 May 1:1077558718774945. Epub 2018 May 1.

2 The Pennsylvania State University, University Park, PA, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718774945DOI Listing
May 2018
6 Reads

Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle.

Authors:
L Michele Issel

Med Care Res Rev 2018 May 1:1077558718774905. Epub 2018 May 1.

1 University of North Carolina at Charlotte, Charlotte, NC, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718774905DOI Listing

The Effect of ACA State Medicaid Expansions on Medical Out-of-Pocket Expenditures.

Med Care Res Rev 2018 May 1:1077558718768895. Epub 2018 May 1.

1 University of Michigan, Ann Arbor, MI, USA.

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. The findings suggest that the expansions were associated with a relatively larger likelihood of having zero premium expenditures and of having zero nonpremium medical out-of-pocket expenditures for low-income individuals. Read More

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http://dx.doi.org/10.1177/1077558718768895DOI Listing

Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care.

Med Care Res Rev 2018 May 1:1077558718771123. Epub 2018 May 1.

4 University of Colorado, Denver, CO, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718771123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212332PMC
May 2018
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Racial and Ethnic Differences in Medicaid Acceptance by Primary Care Physicians: A Geospatial Analysis.

Med Care Res Rev 2018 Apr 1:1077558718772165. Epub 2018 Apr 1.

2 William & Mary, Williamsburg, VA, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718772165DOI Listing

The Role of Organizational Affiliations in Physician Patient-Sharing Relationships.

Med Care Res Rev 2018 Apr 1:1077558718769403. Epub 2018 Apr 1.

2 Boston University, Boston, MA, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718769403DOI Listing
April 2018
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Medicare Bundled Payments for Post-Acute Care: Characteristics and Baseline Performance of Participating Skilled Nursing Facilities.

Med Care Res Rev 2018 Apr 1:1077558718766996. Epub 2018 Apr 1.

1 University of Rochester Medical Center, Rochester, NY, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718766996DOI Listing
April 2018
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A Comprehensive Theory of Integration.

Med Care Res Rev 2018 Mar 1:1077558718767000. Epub 2018 Mar 1.

4 Harvard Medical School Center for Primary Care, Boston, MA, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718767000DOI Listing
March 2018
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NP and PA Privileging in Acute Care Settings: Do Scope of Practice Laws Matter?

Med Care Res Rev 2018 Feb 1:1077558718760333. Epub 2018 Feb 1.

3 American Case Management Association, Little Rock, AR, USA.

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. Read More

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http://dx.doi.org/10.1177/1077558718760333DOI Listing
February 2018
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Effective Governance and Hospital Boards Revisited: Reflections on 25 Years of Research.

Med Care Res Rev 2019 04 31;76(2):131-166. Epub 2018 Jan 31.

1 Auburn University, Auburn, AL, USA.

This study reviews and synthesizes empirical research literature focusing on the relationship between boards of directors and organizational effectiveness of U.S. hospitals. Read More

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http://journals.sagepub.com/doi/10.1177/1077558718754898
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http://dx.doi.org/10.1177/1077558718754898DOI Listing
April 2019
6 Reads

Gender Differences in Hospital CEO Compensation: A National Investigation of Not-for-Profit Hospitals.

Med Care Res Rev 2018 Jan 1:1077558718754573. Epub 2018 Jan 1.

4 Northeastern University, Boston, MA, USA.

Gender pay equity is a desirable social value and an important strategy to fill every organizational stratum with gender-diverse talent to fulfill an organization's goals and mission. This study used national, large-sample data to examine gender difference in CEO compensation among not-for-profit hospitals. Results showed the average unadjusted annual compensation for female CEOs in 2009 was $425,085 compared with $581,121 for male CEOs. Read More

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http://dx.doi.org/10.1177/1077558718754573DOI Listing
January 2018
4 Reads

Dense Breast Notification Laws: Impact on Downstream Imaging After Screening Mammography.

Med Care Res Rev 2018 Jan 1:1077558717751941. Epub 2018 Jan 1.

2 Boston University, Boston, MA, USA.

Dense breast tissue is a common finding that decreases the sensitivity of mammography in detecting cancer. Many states have recently enacted dense breast notification (DBN) laws to provide patients with information to help them make better-informed decisions about their health. To test whether DBN legislation affected the probability of screening mammography follow-up by ultrasound and magnetic resonance imaging (MRI), we examined the proportion of times screening mammography was followed by ultrasound or MRI for a series of months pre- and post-legislation. Read More

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http://dx.doi.org/10.1177/1077558717751941DOI Listing
January 2018
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Relational Climate and Health Care Costs: Evidence From Diabetes Care.

Med Care Res Rev 2018 Jan 1:1077558717751445. Epub 2018 Jan 1.

5 Center of Excellence for Research on Returning War Veterans, Central Texas Healthcare System, Department of Veteran Affairs, Waco, TX.

Quality of care worries and rising costs have resulted in a widespread interest in enhancing the efficiency of health care delivery. One area of increasing interest is in promoting teamwork as a way of coordinating efforts to reduce costs and improve quality, and identifying the characteristics of the work environment that support teamwork. Relational climate is a measure of the work environment that captures shared employee perceptions of teamwork, conflict resolution, and diversity acceptance. Read More

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http://dx.doi.org/10.1177/1077558717751445DOI Listing
January 2018
3 Reads