Medical Care最新文献

{"title":"Improved Items for Estimating SF-36 Profile and Summary Component Scores: Construction and Validation of an 8-Item QOL General (QGEN) Survey.","authors":"John E Ware","doi":"10.1097/MLR.0000000000002122","DOIUrl":"10.1097/MLR.0000000000002122","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive health-related quality of life (QOL) assessment under severe respondent burden constraints requires improved single-item scales for frequently surveyed domains. This article documents how new single-item-per-domain (SIPD) QOL General (QGEN-8) measures were constructed for domains common to SF-36 and results from the first psychometric tests comparing scores for the new measure in relation to those for the SF-36 profile and summary components.</p><p><strong>Research design: </strong>Online NORC surveys of adults, ages 19-93 (mean=52 y) representing the US population in 2020 (N=1648) included QGEN-8 and SF-36 items measuring physical (PF), social (SF), role physical (RP) and role emotional (RE) functioning and feelings of bodily pain (BP), vitality (VT), and mental health (MH). QGEN-8 items were constructed with response categories increasing score ranges for functioning (PF, SF, RP, RE) and directly measuring first-order factors for feelings (BP, VT, and MH). Analyses compared ceiling effects, convergent-discriminant correlations, classic and confirmatory factor analysis (CFA) testing for higher-order physical and mental components, and validity in discriminating across groups differing in comorbid condition severity.</p><p><strong>Results: </strong>QGEN-8 reduced response times by 75% and lowered ceiling effect percentages (-2.2% to -27.8%, median=-14%) in comparison with SF-36. Their common measurement model was supported by: (1) substantial convergent correlations (r=0.576-0.778, median r=0.721) between methods for all domains; (2) lower discriminant correlations between different domains; (3) patterns of factor loadings equivalent to previous studies and adequate CFA model fit; (4) high correlations between methods for physical (r=0.813) and mental (r=0.761) component scores; and (5) equivalent average declines across groups reporting worse comorbid conditions.</p><p><strong>Conclusions: </strong>Overall, results support the use of QGEN-8 to reduce respondent burden and ceiling effects while maintaining convergent and discriminant validity sufficient to estimate group-level SF-36 physical (PCS) and mental (MCS) summary scores. To facilitate its use, QGEN-8 has been made available in multiple languages from the non-profit Mapi Research Trust at https://eprovide.mapi-trust.org .</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"300-310"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Link Between Perceived Racism and Health Services Utilization Among Older Adults: An Analysis of Commonwealth Fund's 2021 International Health Policy Survey.","authors":"Preshit N Ambade, Zachary Hoffman, Kaamya Mehra, Munira Gunja, Justin X Moore","doi":"10.1097/MLR.0000000000002134","DOIUrl":"10.1097/MLR.0000000000002134","url":null,"abstract":"<p><strong>Objectives: </strong>To understand the link between perceived racial/ethnic discrimination among older adults and 2 health service utilization processes: (1) visiting health care providers or emergency room (ER), and (2) repeated visits after the first encounter.</p><p><strong>Methods: </strong>Analysis of 2021 Commonwealth Fund International Health Policy Survey of Older Adults-a nationally representative, self-reported, and cross-sectional survey from Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States. We used a 2-part multivariable hurdle model.</p><p><strong>Results: </strong>Perceived discrimination was associated with 18% reduced odds of visiting at least 1 primary care provider (OR: 0.82; 95% CI: 0.68-0.99). Among those who have visited at least 1 provider, those who perceived discrimination were more likely to visit different providers when compared with those who did not (RR: 1.06; 95% CI: 1.01-1.11). Perceived racism was associated with first (OR: 1.13; 95% CI: 1.01-1.27) and frequent (RR: 1.14; 95% CI: 1.01-1.29) ER visits.</p><p><strong>Conclusions: </strong>Perceived racial discrimination is linked with higher health service utilization among older adults in high-income countries.</p><p><strong>Policy implications: </strong>A multilevel policy response that includes workforce sensitization and diversification, system transparency and accountability, and addressing structural barriers to accessing health care is warranted.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"317-324"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Philadelphia Latine Immigrant Birthing People's Perspectives on Mitigating the Chilling Effect on Prenatal Care Utilization: Erratum.","authors":"","doi":"10.1097/MLR.0000000000002136","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002136","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 4","pages":"316"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The American Rescue Plan Act and Access to Health Care for Latinos According to Citizenship Status.","authors":"Damaris Lopez Mercado, Karoline Mortensen, Alexandra C Rivera-González, Jim P Stimpson, Arturo Vargas Bustamante, Dylan H Roby, Jie Chen, Clara B Barajas, Alexander N Ortega","doi":"10.1097/MLR.0000000000002107","DOIUrl":"10.1097/MLR.0000000000002107","url":null,"abstract":"<p><strong>Objective: </strong>We studied patterns in health care access between Latino and non-Latino White adults according to citizenship status before and after the American Rescue Plan Act (ARPA) of 2021 was enacted to determine whether inequities changed.</p><p><strong>Methods: </strong>This study used 2019-2022 National Health Survey Interview data. Differences in predicted probabilities from logistic regression models were used to estimate changes in health care access outcomes (any insurance coverage, private insurance coverage, delaying care due to cost, and having a usual source of care) among Latino citizens, Latino noncitizens, and non-Latino White citizens in periods before and after ARPA's enactment (2019-2020 vs 2021-2022).</p><p><strong>Results: </strong>Adjusted models observed that inequities in health care access did not change between Latino and non-Latino White citizens from the 2019-2020 period to the 2021-2022 period. Moreover, the health insurance gap widened by 5.8 percentage points between Latino noncitizens and non-Latino White citizens ( P < 0.01) and by 5.2 percentage points between Latino noncitizens and Latino citizens ( P < 0.05) from the 2019-2020 period to the 2021-2022 period. The private insurance coverage gap widened by 6.8 percentage points between Latino noncitizens and non-Latino White citizens ( P < 0.01) and by 6.9 percentage points between Latino noncitizens and Latino citizens ( P < 0.01) from the 2019-2020 period to the 2021-2022 period.</p><p><strong>Conclusion: </strong>ARPA may have helped increase White citizens' insurance coverage, but this benefit did not extend to Latinos, regardless of citizenship status. Developing more inclusive health policies that do not have restrictions based on citizenship and legal authorization status is an important step toward reducing health care inequities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"283-292"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142910013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adding New Components to a Composite Quality Metric: How Good Is Good Enough?","authors":"Stephen Salerno, Eileen Yang, Claudia Dahlerus, Richard A Hirth, Peisong Han, Tao Xu, Ashley Eckard, Wilfred Agbenyikey, Golden M Horton, Stephanie Clark, Joseph M Messana, Yi Li","doi":"10.1097/MLR.0000000000002116","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002116","url":null,"abstract":"<p><strong>Objectives: </strong>This study illustrates how the statistical reliability of an individual measure relates to the overall reliability of a composite metric, as understanding this relationship provides additional information when evaluating measures for endorsement.</p><p><strong>Background: </strong>National quality measure endorsement processes typically evaluate individual metrics on criteria such as importance and scientific acceptability (eg, reliability). In practice, quality measures may be used in composite rating systems, which aid in the interpretation of overall quality differences.</p><p><strong>Methods: </strong>We define an individual measure's reliability by its intraclass correlation and analytically establish the relationship between a composite's reliability and the reliability of its components. We use real data to confirm this relationship under various scenarios. We are motivated by 8 quality measures, which comprise the Quality of Patient Care Star Ratings on Dialysis Facility Care Compare. These measure 4 primary outcomes (mortality, hospitalizations, readmissions, and blood transfusions), vascular access (2 measures), and facility processes (2 measures).</p><p><strong>Results: </strong>Depending on the reliability of the individual measures, their respective weights in the composite, and their pairwise correlations, there are circumstances when adding a new measure, even if it is less reliable, increases the composite's reliability. For the dialysis facility Star Ratings, we find that the combined reliability of measures grouped within certain domains of care exceeded the reliability of the individual measures within those domains.</p><p><strong>Conclusions: </strong>New quality measures may add utility to a composite rating system under certain circumstances-a consideration that should, in part, factor into quality measure endorsement processes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 4","pages":"293-299"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing Clinician Burnout and Turnover: A Call for Systemic Action.","authors":"Kara Zivin","doi":"10.1097/MLR.0000000000002125","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002125","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 4","pages":"270-272"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of External Anchors When Examining Differences in Scale Performance in Patient Experience Surveys.","authors":"Gary A Abel, Ron D Hays, John L Campbell, Marc N Elliott","doi":"10.1097/MLR.0000000000002135","DOIUrl":"10.1097/MLR.0000000000002135","url":null,"abstract":"<p><strong>Objectives: </strong>To present an example of using vignettes as an external anchor to assess measurement equivalence for patient experience measures.</p><p><strong>Background: </strong>Evaluating measurement equivalence and differences in scale use is helpful for identifying disparities in patient experience based on patient surveys. External anchors, often in the form of scored vignettes, provide an attractive approach to examining differences in scale use but are not commonly used.</p><p><strong>Methods: </strong>We analyzed a UK dataset based on the General Practice Patient Survey and a U.S. dataset based on the Consumer Assessment of Healthcare Providers and Systems Clinician and Group survey. A total of 560 White British and 560 Pakistani adults were recruited from various locations across England; 575 Asian American and 505 non-Hispanic White patients were recruited from an internet panel in the United States. Patient encounters and rated the quality of communication using 5 General Practice Patient Survey questions and 3 Consumer Assessment of Healthcare Providers and Systems Clinician and Group questions.</p><p><strong>Results: </strong>Using an external anchor in both United States and UK data produced substantial evidence of differential item functioning (DIF). However, an \"internal\" DIF analysis (without an external anchor) produced little evidence of DIF.</p><p><strong>Conclusions: </strong>Using an external anchor does not require the assumption made by internal methods that some items do not display between-group DIF. These assumptions may not hold for patient experience items if a single factor, such as extreme or negative response tendency, governs all items equally.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"311-316"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout and Turnover Among Veterans Health Administration Primary Care Providers From Fiscal Years 2017-2021.","authors":"Eric A Apaydin, Caroline K Yoo, Susan E Stockdale, Nicholas J Jackson, Elizabeth M Yano, Karin M Nelson, David C Mohr, Danielle E Rose","doi":"10.1097/MLR.0000000000002087","DOIUrl":"10.1097/MLR.0000000000002087","url":null,"abstract":"<p><strong>Objectives: </strong>We examined how individual-level turnover among Veterans Health Administration primary care providers (PCPs) from fiscal years 2017 to 2021 was associated with health care system-level burnout and turnover intent.</p><p><strong>Background: </strong>Burnout among PCPs has been well documented in recent studies, but less is known about the potential relationship between burnout and turnover.</p><p><strong>Methods: </strong>We identified a national cohort of 6444 PCPs (physicians, nurse practitioners, and physician assistants) in 129 Veterans Health Administration health care systems in the first quarter of fiscal year 2017 and tracked their employment status for 20 quarters. PCP employment data on turnover were linked to annual health care system-level employee survey data on burnout, turnover intent, and other covariates. We performed logistic regression to estimate the impact of health care system-level burnout and turnover intent on individual PCP turnover, controlling for individual and health care system-level covariates and adjusting for clustering at the health care system level.</p><p><strong>Results: </strong>Median health care system-level burnout ranged from 42.5% to 52.0% annually, and turnover among PCPs ranged from 6.3% to 8.4% (mean = 7.0%; SD = 0.9%). Separation from employment was higher among employees at health care systems with the highest burnout (odds ratio =1.14; 95% CI = 1.01-1.29) and turnover intent (OR = 1.18; 95% CI = 1.03-1.35).</p><p><strong>Conclusions: </strong>PCPs in health care systems with high burnout are more likely to separate from employment. Policymakers and administrators seeking to improve retention should consider system-level interventions to address organizational drivers of burnout.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"273-282"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142623594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consolidation in an Era of Population Health and Value-Based Care: Implications for Effectiveness, Costs, and Equity.","authors":"Ken Janda, Ben King, Omolola Adepoju, Summer Chavez, Geronimo Bejarano, Robert Tyler Braun, Vivian Ho, Winston Liaw","doi":"10.1097/MLR.0000000000002119","DOIUrl":"10.1097/MLR.0000000000002119","url":null,"abstract":"<p><p>Consolidation of health care providers, and vertical integration of physicians with hospitals and/or payers has accelerated over the past 15 years. Although there is potential for consolidation to improve patient care, efficiencies and reduce overhead costs, participants in our conference identified that almost all research on consolidation has shown increased cost without improvement in outcomes or the experience of care. To provide a framework for considering the impact of consolidation, future research and analysis we offer 4 themes: (1) to move forward, we need to look back at historical drivers, value creation, and unintended consequences; (2) not all consolidation is created equally; (3) real-time, continuous evaluation is critical for improvement; and (4) a policy blueprint is desperately needed. We offer several specific ideas for policy changes.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"267-269"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managed Care in Mental Health Care: How Do We Know When Cost Savings Is Cost-Effective?","authors":"Jennifer L Humensky, Michael C Freed, Agnes Rupp, Rachel Smith, Patricia A Areán","doi":"10.1097/MLR.0000000000002146","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002146","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}