Medical Care最新文献

{"title":"Association Between Medicare's Sepsis Reporting Policy (SEP-1) and the Documentation of a Sepsis Diagnosis in the Clinical Record.","authors":"Ian J Barbash, Billie S Davis, Melissa Saul, Rebecca Hwa, Emily B Brant, Christopher W Seymour, Jeremy M Kahn","doi":"10.1097/mlr.0000000000001997","DOIUrl":"https://doi.org/10.1097/mlr.0000000000001997","url":null,"abstract":"Interrupted time series analysis of a retrospective, electronic health record cohort.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140564484","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":"Hospital Capital Assets, Community Health, and the Utilization and Cost of Inpatient Care: A Population-Based Study of US Counties.","authors":"Adam Gaffney, Danny McCormick, David Bor, Steffie Woolhandler, David U Himmelstein","doi":"10.1097/mlr.0000000000001999","DOIUrl":"https://doi.org/10.1097/mlr.0000000000001999","url":null,"abstract":"The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140564172","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":"Health Care Access and Utilization and the Latino Health Paradox.","authors":"Clara B Barajas, Alexandra C Rivera-González, Arturo Vargas Bustamante, Brent A Langellier, Damaris Lopez Mercado, Ninez A Ponce, Dylan H Roby, Jim P Stimpson, Maria-Elena De Trinidad Young, Alexander N Ortega","doi":"10.1097/mlr.0000000000002004","DOIUrl":"https://doi.org/10.1097/mlr.0000000000002004","url":null,"abstract":"The Latino health paradox is the phenomenon whereby recent Latino immigrants have, on average, better health outcomes on some indicators than Latino immigrants who have lived in the United States longer and US-born Latinos and non-Latino Whites. This study examined whether the paradox holds after accounting for health care access and utilization.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140564179","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":"Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and System Ratings: Associations With Nursing Factors.","authors":"Kathleen E Fitzpatrick Rosenbaum, Karen B Lasater, Mathew D McHugh, Eileen T Lake","doi":"10.1097/mlr.0000000000001966","DOIUrl":"https://doi.org/10.1097/mlr.0000000000001966","url":null,"abstract":"To determine which hospital nursing resources (staffing, skill mix, nurse education, and nurse work environment) are most predictive of hospital Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) performance.","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140564163","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 Impact of Market Factors on Meaningful Use of Electronic Health Records Among Primary Care Providers: Evidence From Florida Using Resource Dependence Theory and Information Uncertainty Perspective.","authors":"Pierre K Alexandre, Judith P Monestime, Kessie Alexandre","doi":"10.1097/MLR.0000000000001980","DOIUrl":"10.1097/MLR.0000000000001980","url":null,"abstract":"<p><strong>Background: </strong>Using federal funds from the 2009 Health Information Technology for Economic and Clinical Health Act, the Centers for Medicare and Medicaid Services funded the 2011-2021 Medicaid electronic health record (EHR) incentive programs throughout the country.</p><p><strong>Objective: </strong>Identify the market factors associated with Meaningful Use (MU) of EHRs after primary care providers (PCPs) enrolled in the Florida-EHR incentives program through Adopting, Improving, or Upgrading (AIU) an EHR technology.</p><p><strong>Research design: </strong>Retrospective cohort study using 2011-2018 program records for 8464 Medicaid providers.</p><p><strong>Main outcome: </strong>MU achievement after first-year incentives.</p><p><strong>Independent variables: </strong>The resource dependence theory and the information uncertainty perspective were used to generate key-independent variables, including the county's rurality, educational attainment, poverty, health maintenance organization penetration, and number of PCPs per capita.</p><p><strong>Analytical approach: </strong>All the county rates were converted into 3 dichotomous measures corresponding to high, medium, and low terciles. Descriptive and bivariate statistics were calculated. A generalized hierarchical linear model was used because MU data were clustered at the county level (level 2) and measured at the practice level (level 1).</p><p><strong>Results: </strong>Overall, 41.9% of Florida Medicaid providers achieved MU after receiving first-year incentives. Rurality was positively associated with MU ( P <0.001). Significant differences in MU achievements were obtained when we compared the \"high\" terciles with the \"low\" terciles for poverty rates ( P =0.002), health maintenance organization penetration rates ( P =0.02), and number of PCPs per capita ( P =0.01). These relationships were negative.</p><p><strong>Conclusions: </strong>Policy makers and health care managers should not ignore the contribution of market factors in EHR adoption.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049841","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":"Association Between a National Behavioral Weight Management Program and Veterans Affairs Health Expenditures.","authors":"Valerie A Smith, Karen M Stechuchak, Edwin S Wong, Anna Hung, Paul A Dennis, Katherine D Hoerster, Dan V Blalock, Susan D Raffa, Matthew L Maciejewski","doi":"10.1097/MLR.0000000000001981","DOIUrl":"10.1097/MLR.0000000000001981","url":null,"abstract":"<p><strong>Objective: </strong>The association between participation in a behavioral weight intervention and health expenditures has not been well characterized. We compared Veterans Affairs (VA) expenditures of individuals participating in MOVE!, a VA behavioral weight loss program, and matched comparators 2 years before and 2 years after MOVE! initiation.</p><p><strong>Methods: </strong>Retrospective cohort study of Veterans who had one or more MOVE! visits in 2008-2017 who were matched contemporaneously to up to 3 comparators with overweight or obesity through sequential stratification on an array of patient characteristics, including sex. Baseline patient characteristics were compared between the two cohorts through standardized mean differences. VA expenditures in the 2 years before MOVE! initiation and 2 years after initiation were modeled using generalized estimating equations with a log link and distribution with variance proportional to the standard deviation (gamma).</p><p><strong>Results: </strong>MOVE! participants (n=499,696) and comparators (n=1,336,172) were well-matched, with an average age of 56, average body mass index of 35, and similar total VA expenditures in the fiscal year before MOVE! initiation ($9662 for MOVE! participants and $10,072 for comparators, standardized mean difference=-0.019). MOVE! participants had total expenditures that were statistically lower than matched comparators in the 6 months after initiation but modestly higher in the 6 months to 2 years after initiation, though differences were small in magnitude (1.0%-1.6% differences).</p><p><strong>Conclusions: </strong>The VA's system-wide behavioral weight intervention did not realize meaningful short-term health care cost savings for participants.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140065405","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":"Ambulatory Care Fragmentation and Total Health Care Costs.","authors":"Lisa M Kern, Joanna B Ringel, Mangala Rajan, Lawrence P Casalino, Michael F Pesko, Laura C Pinheiro, Lisandro D Colantonio, Monika M Safford","doi":"10.1097/MLR.0000000000001982","DOIUrl":"10.1097/MLR.0000000000001982","url":null,"abstract":"<p><strong>Background: </strong>The magnitude of the relationship between ambulatory care fragmentation and subsequent total health care costs is unclear.</p><p><strong>Objective: </strong>To determine the association between ambulatory care fragmentation and total health care costs.</p><p><strong>Research design: </strong>Longitudinal analysis of 15 years of data (2004-2018) from the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, linked to Medicare fee-for-service claims.</p><p><strong>Subjects: </strong>A total of 13,680 Medicare beneficiaries who are 65 years and older.</p><p><strong>Measures: </strong>We measured ambulatory care fragmentation in each calendar year, defining high fragmentation as a reversed Bice-Boxerman Index ≥0.85 and low as <0.85. We used generalized linear models to determine the association between ambulatory care fragmentation in 1 year and total Medicare expenditures (costs) in the following year, adjusting for baseline demographic and clinical characteristics, a time-varying comorbidity index, and accounting for geographic variation in reimbursement and inflation.</p><p><strong>Results: </strong>The average participant was 70.9 years old; approximately half (53%) were women. One-fourth (26%) of participants had high fragmentation in the first year of observation. Those participants had a median of 9 visits to 6 providers, with the most frequently seen provider accounting for 29% of visits. By contrast, participants with low fragmentation had a median of 8 visits to 3 providers, with the most frequently seen provider accounting for 50% of visits. High fragmentation was associated with $1085 more in total adjusted costs per person per year (95% CI $713 to $1457) than low fragmentation.</p><p><strong>Conclusions: </strong>Highly fragmented ambulatory care in 1 year is independently associated with higher total costs the following year.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10926993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140065404","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":"Reexamining Differences Between Black and White Veterans in Hospital Mortality and Other Outcomes in Veterans Affairs and Other Hospitals.","authors":"Jean Yoon","doi":"10.1097/MLR.0000000000001979","DOIUrl":"10.1097/MLR.0000000000001979","url":null,"abstract":"<p><strong>Objectives: </strong>To examine Black-White patient differences in mortality and other hospital outcomes among Veterans treated in Veterans Affairs (VA) and non-VA hospitals.</p><p><strong>Background: </strong>Lower hospital mortality has been documented in older Black patients relative to White patients, yet the mechanisms have not been determined. Comparing other hospital outcomes and multiple hospital systems may help inform the reasons for these differences.</p><p><strong>Methods: </strong>Repeated cross-sectional analysis of hospitalization records was conducted for Veterans discharged in VA and non-VA hospitals from January 1, 2013 to December 31, 2017 in 11 states. Hospital outcomes included 30-day mortality, 30-day readmissions, inpatient costs, and length of stay. Hospitalizations were for acute myocardial infarction, coronary artery bypass graft surgery, gastrointestinal bleeding, heart failure, pneumonia, and stroke. Differences in outcomes were estimated between Black and White patients for VA and non-VA hospitals and age groups younger than 65 years or 65 years and older in regression models adjusting for patient and hospital factors.</p><p><strong>Results: </strong>There were a total of 459,574 study patients. Older Black patients had lower adjusted mortality for acute myocardial infarction, gastrointestinal bleeding, heart failure, and pneumonia. Adjusted probability of readmission was higher and adjusted mean length of stay and costs were greater for older Black patients relative to White patients in non-VA hospitals for several conditions. Fewer differences were observed in younger patients and in VA hospitals.</p><p><strong>Conclusion: </strong>While older Black patients had lower mortality, other outcomes compared poorly with White patients. Differences were not fully explained by observable patient and hospital factors although social determinants may contribute to these differences.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11168193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139692246","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":"Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients.","authors":"Jacqueline Nikpour, Heather Brom, Aleigha Mason, Jesse Chittams, Lusine Poghosyan, Margo Brooks Carthon","doi":"10.1097/MLR.0000000000001951","DOIUrl":"10.1097/MLR.0000000000001951","url":null,"abstract":"<p><strong>Background: </strong>Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases.</p><p><strong>Methods: </strong>Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients' odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores.</p><p><strong>Results: </strong>After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23).</p><p><strong>Conclusions: </strong>As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs' clinical practice environment is a key opportunity to reduce hospitalization disparities.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10949042/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138460808","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":"Association of Continuity of Care With Health Care Utilization and Expenditures Among Patients Discharged Home After Stroke or Transient Ischemic Attack.","authors":"Yucheng Hou, Justin G Trogdon, Janet K Freburger, Cheryl D Bushnell, Jacqueline R Halladay, Pamela W Duncan, Anna M Kucharska-Newton","doi":"10.1097/MLR.0000000000001983","DOIUrl":"10.1097/MLR.0000000000001983","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association of prestroke continuity of care (COC) with postdischarge health care utilization and expenditures.</p><p><strong>Study population: </strong>The study population included 2233 patients with a diagnosis of stroke or a transient ischemic attack hospitalized in one of 41 hospitals in North Carolina between March 2016 and July 2019 and discharged directly home from acute care.</p><p><strong>Methods: </strong>COC was assessed from linked Centers for Medicare and Medicaid Services Medicare claims using the Modified, Modified Continuity Index. Logistic regressions and 2-part models were used to examine the association of prestroke primary care COC with postdischarge health care utilization and expenditures.</p><p><strong>Results: </strong>Relative to patients in the first (lowest) COC quartile, patients in the second and third COC quartiles were more likely [21% (95% CI: 8.5%, 33.5%) and 33% (95% CI: 20.5%, 46.1%), respectively] to have an ambulatory care visit within 14 days. Patients in the highest COC quartile were more likely to visit a primary care provider but less likely to see a stroke specialist. Highest as compared with lowest primary care COC quartile was associated with $45 lower (95% CI: $14, $76) average expenditure for ambulatory care visits within 30 days postdischarge. Patients in the highest, as compared with the lowest, primary care COC quartile were 36% less likely (95% CI: 8%, 64%) to be readmitted within 30 days postdischarge and spent $340 less (95% CI: $2, $678) on unplanned readmissions.</p><p><strong>Conclusions: </strong>These findings underscore the importance of primary care COC received before stroke hospitalization to postdischarge care and expenditures.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140049840","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}