Alyna T Chien, Marshall H Chin, Andrew M Davis, Lawrence P Casalino
{"title":"Pay for performance, public reporting, and racial disparities in health care: how are programs being designed?","authors":"Alyna T Chien, Marshall H Chin, Andrew M Davis, Lawrence P Casalino","doi":"10.1177/1077558707305426","DOIUrl":"https://doi.org/10.1177/1077558707305426","url":null,"abstract":"<p><p>Pay-for-performance and public reporting programs may have a neutral, narrowing, or widening effect on racial disparities in health care. The authors begin this article by suggesting that certain characteristics of these programs may affect disparities. They then present results from a systematic review of the literature on the effects of performance incentive programs on racial disparities in health care. The review revealed that only one empirical study provided data on this issue: It showed that a major public reporting program increased disparities in coronary artery bypass graft rates. The authors then present the results of interviews with leaders of 15 major performance incentive programs in the United States. The interviews indicated that current programs are not designed to reduce disparities and often lack characteristics that may be important in reducing disparities. The article concludes with program leaders' recommendations on how performance incentive programs could be designed to reduce disparities.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"283S-304S"},"PeriodicalIF":2.5,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558707305426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40984737","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}
{"title":"Effects of state managed care patient protection laws on physician satisfaction.","authors":"Frank A Sloan, John R Rattliff, Mark A Hall","doi":"10.1177/1077558707300715","DOIUrl":"https://doi.org/10.1177/1077558707300715","url":null,"abstract":"<p><p>Physician dissatisfaction often drives public policy, and is associated with lower quality of care and disruption of treatment relationships. Physicians expressed strong dissatisfaction with managed care, leading to enactment of patient protection laws. By 2001, almost all states enacted laws to curb alleged abuses of managed care organizations. To date, no studies have examined whether such laws improved physician satisfaction. This article examines whether enactment of these laws improved physician satisfaction, using responses to the Physician Survey component of the Community Tracking Study (CTS), supplemented with data on state statutes/regulations. Career satisfaction increased for both primary care physicians (PCPs) and specialists following enactment of such laws; improvements were limited to early-adopting states. Enactment was associated with improvements in early-adopting states for specialists but not for PCPs on: ability to provide high quality care, clinical freedom, and ability to make clinical decisions in patients' interests without sacrificing physician income.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"585-99"},"PeriodicalIF":2.5,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558707300715","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40983154","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}
Christopher M Masi, Dionne J Blackman, Monica E Peek
{"title":"Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women.","authors":"Christopher M Masi, Dionne J Blackman, Monica E Peek","doi":"10.1177/1077558707305410","DOIUrl":"10.1177/1077558707305410","url":null,"abstract":"<p><p>The authors conduct a systematic review of the literature to identify interventions designed to enhance breast cancer screening, diagnosis, and treatment among minority women. Most trials in this area have focused on breast cancer screening, while relatively few have addressed diagnostic testing or breast cancer treatment. Among patient-targeted screening interventions, those that are culturally tailored or addressed financial or logistical barriers are generally more effective than reminder-based interventions, especially among women with fewer financial resources and those without previous mammography. Chart-based reminders increase physician adherence to mammography guidelines but are less effective at increasing clinical breast examination. Several trials demonstrate that case management is an effective strategy for expediting diagnostic testing after screening abnormalities have been found. Additional support for these and other proven health care organization-based interventions appears justified and may be necessary to eliminate racial and ethnic breast cancer disparities.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"195S-242S"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657605/pdf/nihms-88560.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40984735","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}
{"title":"Adapting a dynamic model of interorganizational cooperation to the health care sector.","authors":"Rebecca Wells, Bryan J Weiner","doi":"10.1177/1077558707301166","DOIUrl":"https://doi.org/10.1177/1077558707301166","url":null,"abstract":"<p><p>Despite a recent proliferation of interorganizational networks in health care, there is very little empirical guidance about how to facilitate their success over time. The current study tests a theory of cooperative evolution in the context of five matched pairs of successful versus \"challenging\" initiatives within six community health center-led networks. Researchers collected initial data in 2000/2001 and conducted follow-up interviews with key informants two years later. Analyses included semi-inductive coding of interview transcripts and systematic comparisons between successful and challenging cooperative efforts. As theory predicts, both initial conditions and subsequent adaptation affected project evolution, with successful and challenging projects following distinct trajectories. The external environment and momentum, however, played more salient roles in these health care safety net networks than they had in corporate ventures. These findings indicate the utility of qualitative techniques to adapt theories developed in other sectors to health care contexts.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"518-43"},"PeriodicalIF":2.5,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558707301166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40983152","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}
{"title":"Do HMOs reduce preventable hospitalizations for Medicare beneficiaries?","authors":"Jayasree Basu, Lee R Mobley","doi":"10.1177/1077558707301955","DOIUrl":"https://doi.org/10.1177/1077558707301955","url":null,"abstract":"This study assesses the association of HMO enrollment with preventable hospitalizations among the elderly in four states. Using 2001 hospital discharge abstracts for elderly Medicare enrollees (age 65 and above) residing in four states (New York, Pennsylvania, Florida, and California), from the Healthcare Cost and Utilization Project (HCUP-SID) database of the Agency for Healthcare Research and Quality, we use a multivariate cross-sectional design with patient-level data for each state. Holding other factors such as demographics and illness severity constant, we find that in three out of four states, Medicare HMO patients had lower odds of a preventable admission versus marker admission than Medicare fee-for-service (FFS) patients. Moreover, in the two states with longest tenure and greatest Medicare HMO penetration, California and Florida, the reduction in preventable admissions among Medicare HMO patients was mainly concentrated among more ill patients. These findings add to the evidence that managed care outperforms traditional care among the elderly, rather than simply skimming off the healthiest populations.","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"544-67"},"PeriodicalIF":2.5,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558707301955","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40983153","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}
Thomas L Fisher, Deborah L Burnet, Elbert S Huang, Marshall H Chin, Kathleen A Cagney
{"title":"Cultural leverage: interventions using culture to narrow racial disparities in health care.","authors":"Thomas L Fisher, Deborah L Burnet, Elbert S Huang, Marshall H Chin, Kathleen A Cagney","doi":"10.1177/1077558707305414","DOIUrl":"10.1177/1077558707305414","url":null,"abstract":"<p><p>The authors reviewed interventions using cultural leverage to narrow racial disparities in health care. Thirty-eight interventions of three types were identified: interventions that modified the health behaviors of individual patients of color, that increased the access of communities of color to the existing health care system, and that modified the health care system to better serve patients of color and their communities. Individual-level interventions typically tapped community members' expertise to shape programs. Access interventions largely involved screening programs, incorporating patient navigators and lay educators. Health care interventions focused on the roles of nurses, counselors, and community health workers to deliver culturally tailored health information. These interventions increased patients' knowledge for self-care, decreased barriers to access, and improved providers' cultural competence. The delivery of processes of care or intermediate health outcomes was significantly improved in 23 interventions. Interventions using cultural leverage show tremendous promise in reducing health disparities, but more research is needed to understand their health effects in combination with other interventions.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"243S-82S"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505343/pdf/nihms49597.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40984736","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}
{"title":"Health disparity: causes, consequences, and change.","authors":"Jeroan J Allison","doi":"10.1177/1077558707305412","DOIUrl":"https://doi.org/10.1177/1077558707305412","url":null,"abstract":"","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"5S-6S"},"PeriodicalIF":2.5,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1077558707305412","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40983155","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}
Andrew M Davis, Lisa M Vinci, Tochi M Okwuosa, Ayana R Chase, Elbert S Huang
{"title":"Cardiovascular health disparities: a systematic review of health care interventions.","authors":"Andrew M Davis, Lisa M Vinci, Tochi M Okwuosa, Ayana R Chase, Elbert S Huang","doi":"10.1177/1077558707305416","DOIUrl":"10.1177/1077558707305416","url":null,"abstract":"<p><p>Racial and ethnic disparities in cardiovascular health care are well documented. Promising approaches to disparity reduction are increasingly described in literature published since 1995, but reports are fragmented by risk, condition, population, and setting. The authors conducted a systematic review of clinically oriented studies in communities of color that addressed hypertension, hyperlipidemia, physical inactivity, tobacco, and two major cardiovascular conditions, coronary artery disease and heart failure. Virtually no literature specifically addressed disparity reduction. The greatest focus has been African American populations, with relatively little work in Hispanic, Asian, and Native American populations. The authors found 62 interventions, 27 addressing hypertension, 9 lipids, 18 tobacco use, 8 physical inactivity, and 7 heart failure. Only 1 study specifically addressed postmyocardial infarction care. Data supporting the value of registries, multidisciplinary teams, and community outreach were found across several conditions. Interventions addressing care transitions, using telephonic outreach, and promoting medication access and adherence merit further exploration.</p>","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":" ","pages":"29S-100S"},"PeriodicalIF":0.0,"publicationDate":"2007-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367222/pdf/nihms-44292.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40983157","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}
{"title":"U.S. civil rights policy and access to health care by minority Americans: implications for a changing health care system.","authors":"S. Rosenbaum, A. Markus, J. Darnell","doi":"10.1177/107755800773743673","DOIUrl":"https://doi.org/10.1177/107755800773743673","url":null,"abstract":"The history of health care discrimination as well as ongoing, extensive evidence of racial disparities argue for continued vigilance in the area of health care and civil rights. Under Title VI of the Civil Rights Act of 1964, individuals have challenged de facto discriminatory policies adopted by health entities receiving federal financial assistance. Title VI health litigation is difficult because of complex issues of proof as well as confounding problems of poverty and lack of health insurance that affect both claims and remedies. An analysis of cases brought under the law suggests that discrimination claims within a particular market fare better than those challenging decisions to relocate or alter the market served. This has important implications for claims involving discrimination by managed care organizations. Because the same potential for discrimination exists in the new health system of managed care, although in altered form, data collection and evaluation are warranted.","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123661978","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}
{"title":"Translating behavioral health services research into benefits policy.","authors":"K. Grazier, H. Pollack","doi":"10.1177/107755800773743727","DOIUrl":"https://doi.org/10.1177/107755800773743727","url":null,"abstract":"This article uses a 4-pronged statistical approach to examine the impact of a mental health carve-out at a major employer. To examine net financial impact of the carve-out, the authors perform a pre-post, multivariate regression analysis of changes in costs. Using a random-effects model, the authors explore the ultimate financial impact of the carve-out for patients and for the firm. Using a multinomial logistic regression, they examine differing program effects by intensity of use. A fixed-effects negative binomial regression models the episodic nature of outpatient care, controlling for patient-specific unobserved characteristics that influence health care utilization. The carve-out slightly reduced overall mental health costs and utilization while expanding entry-level access to routine services. At the same time, the specific carve-out shifted financial burdens from the firm onto high-utilization patients. Therefore, this carve-out appears poorly suited to the care of individuals experiencing severe and debilitating psychiatric disorders.","PeriodicalId":169610,"journal":{"name":"Medical care research and review : MCRR","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125079695","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}