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Public Reporting and Consumer Demand in the Home Health Sector. 家庭保健领域的公共报告和消费者需求。
IF 2.4 3区 医学
Medical Care Research and Review Pub Date : 2024-04-01 Epub Date: 2024-01-18 DOI: 10.1177/10775587231221852
Jun Li
{"title":"Public Reporting and Consumer Demand in the Home Health Sector.","authors":"Jun Li","doi":"10.1177/10775587231221852","DOIUrl":"10.1177/10775587231221852","url":null,"abstract":"<p><p>Health care report cards improve information and are a crucial part of health care reform of the federal government of the United States. I exploit a natural experiment in the home health sector to assess whether a higher rating under the star ratings program affects patient choice. Higher rated agencies increased their market share by 1.4% or 0.25 (95% confidence interval: [-0.63, 1.12]) percentage points, a practically and statistically insignificant amount. I find no evidence of heterogeneous effects across the rating distribution or over time. I also find precise null effects among consumers expected to be more responsive, including community-entry patients and patients in competitive markets with more options and star types. Agencies may have modestly impeded consumer choice by engaging in some patient selection behaviors, although the evidence is only weakly suggestive. The star ratings are unlikely to improve home health quality despite continued policymaker interest.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"122-132"},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10939869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trends and Disparities in Perinatal Opioid Use Disorder Treatment in Medicaid, 2007-2012. 2007-2012 年医疗补助中围产期阿片类药物使用障碍治疗的趋势和差异。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-04-01 Epub Date: 2023-12-31 DOI: 10.1177/10775587231216515
Rachel K Landis, Bradley D Stein, Andrew W Dick, Beth Ann Griffin, Brendan K Saloner, Mishka Terplan, Laura J Faherty
{"title":"Trends and Disparities in Perinatal Opioid Use Disorder Treatment in Medicaid, 2007-2012.","authors":"Rachel K Landis, Bradley D Stein, Andrew W Dick, Beth Ann Griffin, Brendan K Saloner, Mishka Terplan, Laura J Faherty","doi":"10.1177/10775587231216515","DOIUrl":"10.1177/10775587231216515","url":null,"abstract":"<p><p>We described Medicaid-insured women by receipt of perinatal opioid use disorder (OUD) treatment; and trends and disparities in treatment. Using 2007 to 2012 Medicaid Analytic eXtract data from 45 states and D.C., we identified deliveries among women with OUD. Regressions modeled the association between patient characteristics and receipt of any OUD treatment, medication for OUD (MOUD), and counseling alone during the perinatal period. Rates of any OUD treatment and MOUD for women with perinatal OUD increased over the study period, but trends differed by subgroup. Compared with non-Hispanic White women, Black and American Indian/Alaskan Native (AI/AN) women were less likely to receive any OUD treatment, and Black women were less likely to receive MOUD. Over time, the disparity in receipt of MOUD between Black and White women increased. Overall gains in OUD treatment were driven by improvements in perinatal OUD care for White women and obscured disparities for Black and AI/AN women.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"145-155"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139075809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Introducing a Measure of Hospital Community Orientation. 引入医院社区导向衡量标准。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-04-01 Epub Date: 2024-01-18 DOI: 10.1177/10775587231225795
Henry S Stabler, Timothy Beebe, Katie White
{"title":"Introducing a Measure of Hospital Community Orientation.","authors":"Henry S Stabler, Timothy Beebe, Katie White","doi":"10.1177/10775587231225795","DOIUrl":"10.1177/10775587231225795","url":null,"abstract":"<p><p>Policymakers have long sought to encourage hospitals to assume a more collaborative role in improving community health. By urging hospitals to interact with community stakeholders, more integrative relationships may result that can better address local health issues. This study establishes a composite measure of hospital community orientation, defined as the extent to which a hospital uses community resources and knowledge in its community benefit (CB) work, based on an expansion of CB regulations that require nonprofit hospitals (NPHs) to develop strategies to address prioritized health issues. We collected data on each proposed intervention from 125 randomly selected NPHs over three reporting periods. Confirmatory factor analysis was used to assess how well a single-factor model approximated community orientation. We conclude that using hospital community orientation measurement is a useful metric to assess the effects of expanded CB regulations, as well as to determine how NPHs have interacted with communities over time.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"96-106"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prescribing by Physician Associates and Nurse Practitioners in Older Adults Is Outpacing Traditional Prescribers: Implications for Practice in American Medicine. 老年医师和执业护士的处方正在超过传统处方:对美国医学实践的启示。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-04-01 Epub Date: 2023-11-29 DOI: 10.1177/10775587231211966
Roderick S Hooker, John M Zobitz
{"title":"Prescribing by Physician Associates and Nurse Practitioners in Older Adults Is Outpacing Traditional Prescribers: Implications for Practice in American Medicine.","authors":"Roderick S Hooker, John M Zobitz","doi":"10.1177/10775587231211966","DOIUrl":"10.1177/10775587231211966","url":null,"abstract":"<p><p>Prescribing is a significant activity undertaken by physicians, physician associates/assistants (PAs), and nurse practitioners (NPs). We analyzed prescribing data to understand better the growing presence of PAs and NPs in older adults. A trend in frequently prescribed medications was compared with other physicians. All prescriptions in Medicare Part D were grouped into broad categories of drugs and linked to each type of provider. The analysis spanned 9 years (2013-2021). The results revealed that all five providers similarly prescribed the top three main drug classes (antacids, antihypertensives, and statins). In addition, there was a decline in the number of unique prescribers and prescriptions for all three types of physicians (family medicine, internal medicine, and general practice physicians). Concurrently, the number and share of prescriptions for NPs and PAs increased yearly. The findings are consistent with data that PAs and NPs are backfilling physician shortages in treating older adults.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"156-163"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138453041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Uncompensated Care is Highest for Rural Hospitals, Particularly in Non-Expansion States. 农村医院的无偿护理最高，特别是在未扩大规模的州。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-04-01 Epub Date: 2023-11-18 DOI: 10.1177/10775587231211366
Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George H Pink
{"title":"Uncompensated Care is Highest for Rural Hospitals, Particularly in Non-Expansion States.","authors":"Emmaline Keesee, Susie Gurzenda, Kristie Thompson, George H Pink","doi":"10.1177/10775587231211366","DOIUrl":"10.1177/10775587231211366","url":null,"abstract":"<p><p>High levels of uncompensated care impact hospital profitability and may create challenges for rural hospitals at financial risk of closure. We explore 2019 hospital uncompensated care as a percentage of operating expenses and draw comparisons at a state level by Medicaid expansion status and rural classification. We further compare uncompensated care in 2019 to 2014 in rural hospitals by Medicaid expansion implementation timing. We found that, overall, rural hospitals had more uncompensated care than urban hospitals in 2019 (3.81% vs. 3.12%), but there was a larger difference by expansion status (expansion states: 2.55% vs. non-expansion states: 6.28%). In all but seven states, rural hospitals reported higher uncompensated care than urban, and the 14 states with the highest uncompensated care had not expanded Medicaid. We observed that rural hospital uncompensated care in non-expansion states increased between 2014 and 2019, while the most dramatic decrease occurred in late-expansion states.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"164-170"},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10924546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136400181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Access to Health Care for Transgender and Gender-Diverse Adults in Urban and Rural Areas in the United States. 美国城市和农村地区变性和性别多元化成年人获得医疗保健的情况。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-02-01 Epub Date: 2023-08-07 DOI: 10.1177/10775587231191649
Hannah MacDougall, Carrie Henning-Smith, Gilbert Gonzales, Austen Ott
{"title":"Access to Health Care for Transgender and Gender-Diverse Adults in Urban and Rural Areas in the United States.","authors":"Hannah MacDougall, Carrie Henning-Smith, Gilbert Gonzales, Austen Ott","doi":"10.1177/10775587231191649","DOIUrl":"10.1177/10775587231191649","url":null,"abstract":"<p><p>The objective of this study is to examine access to care based on gender identity in urban and rural areas, focusing on transgender and gender diverse (TGD) populations. Data on TGD (<i>n</i> = 1,678) and cisgender adults (<i>n</i> = 403,414) from the 2019 to 2020 Behavioral Risk Factor Surveillance System were used. Outcome measures were four barriers to care. We conducted bivariate and multivariable logistic regressions to assess associations between access, rurality, and gender identity. Bivariate results show that TGD adults were significantly more likely to experience three barriers to care. In multivariable models, TGD adults were more likely to delay care due to cost in the full sample (adjusted odds ratio [AOR]: 2.00, <i>p</i> < .001), rural subsample (AOR: 2.14, <i>p</i> < .01), and urban subsample (AOR: 1.97, <i>p</i> < .01). This study revealed greater barriers to care for TGD adults, with the most frequent barriers found among rural TGD adults. Increased provider awareness and structural policy changes are needed to achieve health equity for rural TGD populations.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"68-77"},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10302848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Meta-Analysis of the Impact of Four Advanced Primary Care Redesign Initiatives on Medicare Expenditures. 四项高级初级医疗重新设计计划对医疗保险支出影响的 Meta 分析。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-02-01 Epub Date: 2023-08-30 DOI: 10.1177/10775587231194658
Kevin W Smith, Eva Chang, Elliott Liebling, Anupa Bir
{"title":"Meta-Analysis of the Impact of Four Advanced Primary Care Redesign Initiatives on Medicare Expenditures.","authors":"Kevin W Smith, Eva Chang, Elliott Liebling, Anupa Bir","doi":"10.1177/10775587231194658","DOIUrl":"10.1177/10775587231194658","url":null,"abstract":"<p><p>We conducted a secondary analysis of the evaluations of 22 sites participating in four primary care redesign initiatives funded by the Centers for Medicare and Medicaid Services or the Center for Medicare and Medicaid Innovation. Our objectives were to determine the overall impact of the initiatives on Medicare expenditures and whether specific site-level program features influenced expenditure findings. Averaged over sites, the mean intervention effect was a statistically insignificant US$26 per beneficiary per year. Policy implications from meta-regression results suggest that funders should consider supporting technical assistance efforts and pay for performance incentives to increase savings. There was no evidence that paying for medical home transformation produced savings in total cost of care. We estimate that in future evaluations, data from 35 sites would be needed to detect feature effects of US$300 per beneficiary per year.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"49-57"},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10168164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association Between Community Social Vulnerability and Preventable Hospitalizations. 社区社会脆弱性与可预防住院之间的关系。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-02-01 Epub Date: 2023-09-21 DOI: 10.1177/10775587231197248
Rachel Hogg-Graham, Joseph A Benitez, Mary E Lacy, Joshua Bush, Juan Lang, Haritomane Nikolaou, Emily R Clear, J M McCullough, Teresa M Waters
{"title":"Association Between Community Social Vulnerability and Preventable Hospitalizations.","authors":"Rachel Hogg-Graham, Joseph A Benitez, Mary E Lacy, Joshua Bush, Juan Lang, Haritomane Nikolaou, Emily R Clear, J M McCullough, Teresa M Waters","doi":"10.1177/10775587231197248","DOIUrl":"10.1177/10775587231197248","url":null,"abstract":"<p><p>Preventable hospitalizations are common and costly events that burden patients and our health care system. While research suggests that these events are strongly linked to ambulatory care access, emerging evidence suggests they may also be sensitive to a patient's social, environmental, and economic conditions. This study examines the association between variations in social vulnerability and preventable hospitalization rates. We conducted a cross-sectional analysis of county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). Preventable hospitalizations were 40% higher in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm the strong relationship between social vulnerability and preventable hospitalizations. Our results suggest wide variation in community-level preventable hospitalization rates, with robust evidence that variation is strongly related to a community's social vulnerability. The human toll, societal cost, and preventability of these hospitalizations make understanding and mitigating these inequities a national priority.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"31-38"},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41170197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Does Interdisciplinary Care Team Care Management Improve Health Quality and Demonstrate Cost-Effectiveness? 跨学科护理团队的护理管理是否能提高医疗质量并体现成本效益？
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-02-01 Epub Date: 2023-09-07 DOI: 10.1177/10775587231197846
F Cardwell Feagin, Larry R Hearld, Nathan W Carroll, Stephen O'Connor, Bisakha Sen
{"title":"Does Interdisciplinary Care Team Care Management Improve Health Quality and Demonstrate Cost-Effectiveness?","authors":"F Cardwell Feagin, Larry R Hearld, Nathan W Carroll, Stephen O'Connor, Bisakha Sen","doi":"10.1177/10775587231197846","DOIUrl":"10.1177/10775587231197846","url":null,"abstract":"<p><p>This study evaluated the impact of an interdisciplinary care teams (IDCT) care management program on cost and quality outcomes using a novel algorithm to identify 400 high-risk patients out of 48,235 Medicare Advantage (MA) beneficiaries. Of the 400, 252 were enrolled in the IDCT care management intervention program, while the remaining 148 were not enrolled. A second comparison group consisted of 660 who were referred to the IDCT program but not selected by the algorithm. The program's effectiveness was evaluated 1-year postintervention. Analyses found that health care costs for members enrolled in the IDCT program were reduced by US$1,121.76 and US$1,625.61 per member per month, respectively, relative to those not enrolled and those enrolled by referral. The cost reduction from the program generated a net savings of US$1.9MM, covering the program's cost. Findings suggest IDCTs can cost-effectively manage populations of high-risk patients with better selection and fostering greater interdependence.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"19-30"},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10553332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Do Insurers With Greater Market Power Negotiate Consistently Lower Prices for Hospital Care? Evidence From Hospital Price Transparency Data. 拥有更大市场支配力的保险公司是否在谈判中始终降低医院护理价格？来自医院价格透明数据的证据。
IF 2.5 3区 医学
Medical Care Research and Review Pub Date : 2024-02-01 Epub Date: 2023-08-18 DOI: 10.1177/10775587231193475
Yang Wang, Mark K Meiselbach, Jianhui Xu, Ge Bai, Gerard Anderson
{"title":"Do Insurers With Greater Market Power Negotiate Consistently Lower Prices for Hospital Care? Evidence From Hospital Price Transparency Data.","authors":"Yang Wang, Mark K Meiselbach, Jianhui Xu, Ge Bai, Gerard Anderson","doi":"10.1177/10775587231193475","DOIUrl":"10.1177/10775587231193475","url":null,"abstract":"<p><p>This study examined if greater insurer market power was associated with consistently lower negotiated prices within each hospital for 44 shoppable and emergency procedures, using price transparency data disclosed by 1,506 hospitals in metropolitan areas. We used multi-level fixed effects models to estimate the within-hospital variation in plan-level insurer-negotiated prices (from the largest insurer, the second largest insurer, other major insurers, and nonmajor insurers) and cash-pay prices as a function of insurer market power. For shoppable services, relative to nonmajor insurers, the largest, second largest, and other major insurers negotiated 23%, 16%, and 3% lower prices, respectively, while cash prices were 17% higher. For emergency room visits, while the largest insurers paid 5% less than nonmajor insurers, the second largest and other major insurers did not pay lower prices. Stratified analyses by type of shoppable services found varying magnitudes and patterns of price discounts associated with insurer market power.</p>","PeriodicalId":51127,"journal":{"name":"Medical Care Research and Review","volume":" ","pages":"78-84"},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10019210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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