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Medical care research and review : MCRR最新文献

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Geographic variation: a view from the hospital sector. 地域差异:来自医院部门的观点。
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-12-01 Epub Date: 2011-05-19 DOI: 10.1177/1077558711408325
Rachel Mosher Henke, William D Marder, Bernard S Friedman, Herbert S Wong
{"title":"Geographic variation: a view from the hospital sector.","authors":"Rachel Mosher Henke,&nbsp;William D Marder,&nbsp;Bernard S Friedman,&nbsp;Herbert S Wong","doi":"10.1177/1077558711408325","DOIUrl":"https://doi.org/10.1177/1077558711408325","url":null,"abstract":"<p><p>Efforts to characterize geographic variation in health care utilization and spending have focused on patterns observed with Medicare data. The authors analyzed the Healthcare Cost and Utilization Project national all-payer data for inpatient stays to assess variation in hospitalizations by age groups and, consequently, to understand how utilization of the Medicare population may differ from the population of other payers. The authors found that the correlation between inpatient discharges and costs per capita for the Medicare-eligible population over 65 and younger age groups increased from moderate to strong with age. These findings suggest examining Medicare inpatient data alone may provide a useful but not comprehensive understanding how hospital utilization and costs vary for the total population.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"699-711"},"PeriodicalIF":2.5,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558711408325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40100126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 384
Implementing small group health insurance reform: the HEALTHpact plan of Rhode Island. 实施小组医疗保险改革:罗德岛州的健康契约计划。
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-12-01 Epub Date: 2011-05-19 DOI: 10.1177/1077558711409048
Edward Alan Miller, Amal N Trivedi, Sylvia Kuo, Vincent Mor
{"title":"Implementing small group health insurance reform: the HEALTHpact plan of Rhode Island.","authors":"Edward Alan Miller,&nbsp;Amal N Trivedi,&nbsp;Sylvia Kuo,&nbsp;Vincent Mor","doi":"10.1177/1077558711409048","DOIUrl":"https://doi.org/10.1177/1077558711409048","url":null,"abstract":"<p><p>This study analyzes administrative impediments to enrollment in HEALTHpact, a high-deductible plan with premiums capped at 10% of the average Rhode Island wage. HEALTHpact includes an opportunity for enrollees to reduce their deductibles from $5,000 ($10,000 for a family) to $750 ($1,500 for a family) if they engage in prespecified wellness behaviors. A stakeholder panel was convened to develop guidelines for insurers, which, in turn, were required to develop products satisfying those guidelines. Implementation was examined using stakeholder interviews and archival documents. Results indicate that since no funds were allocated for education and monitoring, there was little opportunity to promote \"bottom up\" demand or to oversee insurers. They also indicate that both insurers and brokers adopted strategies that inhibited take-up. Providing the resources necessary for effective government oversight and outreach will be critical to small group market reform nationally. So too will be promoting broker and insurer buy-in.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"712-24"},"PeriodicalIF":2.5,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558711409048","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40100130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Medicare's payment policy for hospital-acquired conditions: perspectives of administrators from safety net hospitals. 医疗保险对医院获得性疾病的支付政策:来自安全网医院管理者的观点。
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-12-01 Epub Date: 2011-05-19 DOI: 10.1177/1077558711408326
Megan McHugh, Kevin Van Dyke, Awo Osei-Anto, Ahmed Haque
{"title":"Medicare's payment policy for hospital-acquired conditions: perspectives of administrators from safety net hospitals.","authors":"Megan McHugh,&nbsp;Kevin Van Dyke,&nbsp;Awo Osei-Anto,&nbsp;Ahmed Haque","doi":"10.1177/1077558711408326","DOIUrl":"https://doi.org/10.1177/1077558711408326","url":null,"abstract":"<p><p>In 2008, Medicare implemented a policy limiting reimbursement to hospitals for treating avoidable hospital-acquired conditions (HACs). Although the policy will expand nationally to Medicaid programs in 2011, little is known about the impact on safety net hospitals. The authors conducted interviews with 60 chief quality officers and 55 chief financial officers from safety net hospitals to explore the impact of Medicare's HACs policy during its first year. Despite the predicted small financial impact, the authors found that the policy gained the attention of hospital leaders and many governing boards. Although the policy reportedly provided additional motivation to reduce HACs, few hospitals implemented new care practices and instead focused on documenting conditions that are present for patients on admission. The findings also illustrate the need for Centers for Medicare & Medicaid Services to provide more guidance to the industry when this type of policy is introduced.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"667-82"},"PeriodicalIF":2.5,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558711408326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40100129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 21
Structural estimates of treatment effects on outcomes using retrospective data: an application to ductal carcinoma in situ. 使用回顾性数据对治疗效果的结构性评估:导管原位癌的应用。
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-12-01 Epub Date: 2011-05-19 DOI: 10.1177/1077558711408324
Heather Taffet Gold, Melony E S Sorbero, Jennifer J Griggs, Huong T Do, Andrew W Dick
{"title":"Structural estimates of treatment effects on outcomes using retrospective data: an application to ductal carcinoma in situ.","authors":"Heather Taffet Gold,&nbsp;Melony E S Sorbero,&nbsp;Jennifer J Griggs,&nbsp;Huong T Do,&nbsp;Andrew W Dick","doi":"10.1177/1077558711408324","DOIUrl":"https://doi.org/10.1177/1077558711408324","url":null,"abstract":"<p><p>Analysis of observational cohort data is subject to bias from unobservable risk selection. The authors compared econometric models and treatment effectiveness estimates using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data for women diagnosed with ductal carcinoma in situ. Treatment effectiveness estimates for mastectomy and breast-conserving surgery (BCS) with or without radiotherapy were compared using three different models: simultaneous-equations model, discrete-time survival model with unobserved heterogeneity (frailty), and proportional hazards model. Overall trends in disease-free survival (DFS), or time to first subsequent breast event, by treatment are similar regardless of the model, with mastectomy yielding the highest DFS over 8 years of follow-up, followed by BCS with radiotherapy, and then BCS alone. Absolute rates and direction of bias varied substantially by treatment strategy. DFS was underestimated by single-equation and frailty models compared with the simultaneous-equations model and randomized controlled trial results for BCS with radiotherapy and overestimated for BCS alone.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"627-49"},"PeriodicalIF":2.5,"publicationDate":"2011-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558711408324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40100127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Longitudinal analysis of market factors associated with provision of peritoneal dialysis services. 与提供腹膜透析服务相关的市场因素的纵向分析。
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-10-01 Epub Date: 2011-05-19 DOI: 10.1177/1077558711399768
Virginia Wang, Shoou-Yih D Lee, Uptal D Patel, Matthew L Maciejewski, Thomas C Ricketts
{"title":"Longitudinal analysis of market factors associated with provision of peritoneal dialysis services.","authors":"Virginia Wang,&nbsp;Shoou-Yih D Lee,&nbsp;Uptal D Patel,&nbsp;Matthew L Maciejewski,&nbsp;Thomas C Ricketts","doi":"10.1177/1077558711399768","DOIUrl":"https://doi.org/10.1177/1077558711399768","url":null,"abstract":"<p><p>Despite the appeal of peritoneal dialysis (PD) among patients, payers, and providers, its use in the United States has been limited and declining. Prior research has found that patient factors explain little variation in PD utilization, and little is known about the contribution of dialysis facility factors. The authors examined market factors associated with the provision of PD services in dialysis facilities between 1995 and 2003. Less than half of dialysis facilities offered PD. PD provision was not explained by disease trends or patient characteristics commonly associated with PD use. Facilities were more likely to offer PD in less competitive and less spatially concentrated markets. PD services may not be available to all patients who would benefit from it and there may be insufficient demand, economics of scale, or incentives for facilities to provide PD. These findings warrant further investigation on dialysis facilities' provision of a preferred, potentially beneficial, and cost-effective therapy.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"537-58"},"PeriodicalIF":2.5,"publicationDate":"2011-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558711399768","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40100128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 15
Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time? 解释2003年至2007年间医疗账单带来的家庭经济压力的增加:负担能力阈值会随着时间而变化吗?
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-06-01 Epub Date: 2010-09-09 DOI: 10.1177/1077558710378122
Peter J Cunningham
{"title":"Explaining the increase in family financial pressures from medical bills between 2003 and 2007: do affordability thresholds change over time?","authors":"Peter J Cunningham","doi":"10.1177/1077558710378122","DOIUrl":"https://doi.org/10.1177/1077558710378122","url":null,"abstract":"<p><p>This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills--defined as the percent with problems paying medical bills--increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that \"affordability thresholds\" for medical care as defined by individuals and families are not stable over time, especially for lower-income persons, which has implications for setting affordability standards in health reform.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"352-66"},"PeriodicalIF":2.5,"publicationDate":"2011-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558710378122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 12
Strategy, structure, and patient quality outcomes in ambulatory surgery centers (1997-2004). 策略、结构和门诊手术中心的患者质量结果(1997-2004)。
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-04-01 Epub Date: 2010-09-09 DOI: 10.1177/1077558710378523
Askar Chukmaitov, Kelly J Devers, David W Harless, Nir Menachemi, Robert G Brooks
{"title":"Strategy, structure, and patient quality outcomes in ambulatory surgery centers (1997-2004).","authors":"Askar Chukmaitov,&nbsp;Kelly J Devers,&nbsp;David W Harless,&nbsp;Nir Menachemi,&nbsp;Robert G Brooks","doi":"10.1177/1077558710378523","DOIUrl":"https://doi.org/10.1177/1077558710378523","url":null,"abstract":"<p><p>The purpose of this study was to examine potential associations among ambulatory surgery centers' (ASCs) organizational strategy, structure, and quality performance. The authors obtained several large-scale, all-payer claims data sets for the 1997 to 2004 period. The authors operationalized quality performance as unplanned hospitalizations at 30 days after outpatient arthroscopy and colonoscopy procedures. The authors draw on related organizational theory, behavior, and health services research literatures to develop their conceptual framework and hypotheses and fitted fixed and random effects Poisson regression models with the count of unplanned hospitalizations. Consistent with the key hypotheses formulated, the findings suggest that higher levels of specialization and the volume of procedures may be associated with a decrease in unplanned hospitalizations at ASCs.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"202-25"},"PeriodicalIF":2.5,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558710378523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 23
Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. 老年人急诊科使用:未满足卫生保健需求的趋势、适当性和后果的文献综述。
IF 2.5
Medical care research and review : MCRR Pub Date : 2011-04-01 Epub Date: 2010-09-09 DOI: 10.1177/1077558710379422
Andrea Gruneir, Mara J Silver, Paula A Rochon
{"title":"Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs.","authors":"Andrea Gruneir,&nbsp;Mara J Silver,&nbsp;Paula A Rochon","doi":"10.1177/1077558710379422","DOIUrl":"https://doi.org/10.1177/1077558710379422","url":null,"abstract":"<p><p>Older adults use emergency departments (EDs) more than any other age group and are more prone to subsequent adverse events. This article reviews the literature on ED use by older adults within the context of evaluating their need for emergency care and the extent to which access to primary and supportive care services affect use. While a substantial research literature describes general patterns of ED use, there is much less research on ED use as a function of other health service use. Gaps in the research literature result in a limited understanding of the full scope of the issue and opportunities for practice and policy intervention.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"131-55"},"PeriodicalIF":2.5,"publicationDate":"2011-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558710379422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 177
Reducing disparities in health care quality: the role of health IT in underresourced settings. 缩小卫生保健质量差距:卫生信息技术在资源不足环境中的作用。
IF 2.5
Medical care research and review : MCRR Pub Date : 2010-10-01 Epub Date: 2010-09-09 DOI: 10.1177/1077558710376202
Michael Chris Gibbons, Cecilia Rivera Casale
{"title":"Reducing disparities in health care quality: the role of health IT in underresourced settings.","authors":"Michael Chris Gibbons,&nbsp;Cecilia Rivera Casale","doi":"10.1177/1077558710376202","DOIUrl":"https://doi.org/10.1177/1077558710376202","url":null,"abstract":"<p><p>Health information technology (health IT) and the Internet have tremendous potential to transform health care. The implications of the adoption of health IT within the context of underresourced health care settings have not been adequately evaluated. For this reason, the Agency for Healthcare Research and Quality sponsored a 2-day invitational expert meeting in October 2009. The theme of the meeting was \"Reducing Disparities in Healthcare Quality in Under Resourced Settings Using HIT and Other Quality Improvement Strategies.\" In preparation for the meeting, five background manuscripts were commissioned, presented, and discussed. Attendees also participated in one of three breakout sessions. Several overarching themes, key recommendations, and research topics emerged across five general categories of (a) the health care delivery setting, (b) research and evaluation methodologies, (c) patients and target populations, (d) technology applications and platforms, and (e) providers and clinicians. This article outlines the process, findings, and key recommendations of this expert workshop.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"155S-162S"},"PeriodicalIF":2.5,"publicationDate":"2010-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558710376202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 36
Mental health and family out-of-pocket expenditure burdens. 心理健康和家庭自费支出负担。
IF 2.5
Medical care research and review : MCRR Pub Date : 2010-04-01 Epub Date: 2009-09-22 DOI: 10.1177/1077558709345499
Samuel H Zuvekas, Thomas M Selden
{"title":"Mental health and family out-of-pocket expenditure burdens.","authors":"Samuel H Zuvekas,&nbsp;Thomas M Selden","doi":"10.1177/1077558709345499","DOIUrl":"https://doi.org/10.1177/1077558709345499","url":null,"abstract":"<p><p>A growing literature finds that a significant fraction of American families experience high or \"catastrophic\" burdens of medical spending. Families facing mental health problems may be especially vulnerable to high burdens. This study uses data from the Medical Expenditure Panel Survey to determine the annual and within-year concentration of medical spending and the extent to which mental health treatment contributes to high out-of-pocket burdens among families with and without mental health problems. On average, families incurred 44% of non-mental health and 37% of out-of-pocket mental health treatment expenditures in a single month. Families with one or more members experiencing mental health problems were more likely to have periods of high out-of-pocket spending burdens. However, this study found that mental health treatment itself contributes little to high out-of-pocket spending burdens. Most of the burden was due to other medical conditions and lower average incomes among families with mental health problems.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"194-212"},"PeriodicalIF":2.5,"publicationDate":"2010-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558709345499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40029754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 20
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