MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Medical Care Research and Review' source. Sat, 20 Mar 2010 15:50:42 +0100 http://www.medworm.com/index.php?rid=3334091&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F2%2F232%3Frss%3D1 A positive relationship has been demonstrated between the quality of care delivered in nursing homes and the quality of nursing staff providing the care. The general perception, however, is that there is a decline in registered nurses’ staff hours in nursing homes. The primary objective of this study is to investigate whether the levels of registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants (NAs) as well as skill mix has changed in nursing homes between the years 1997 and 2007. A descriptive research design was employed on data derived from Online Survey Certification and Reporting System database. After accounting for facility size and ownership, it was found that more nursing homes have increased—rather than decreased—LPN and NA hours per r... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3334091 Thu, 04 Mar 2010 23:55:16 +0100 3334091 http://www.medworm.com/index.php?rid=3334090&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F2%2F213%3Frss%3D1 This study examines trends in the diffusion of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) during 1993-2004 for patients with acute myocardial infarction in markets with and without Certificate of Need (CON) regulations for open-heart surgery or cardiac catheterization and in markets that repealed CON for either of these procedures. In contrast to prior studies, this study accounts for regional hospital markets that cross state boundaries—often with different CON activities in each state. The overall use of CABG increased modestly throughout the 1990s and subsequently decreased, corresponding to a dramatic increase in PCI. There was a greater rise in the number of CABG programs in markets with significant reduction in CON regulations during 1993-2... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3334090 Thu, 04 Mar 2010 23:55:16 +0100 3334090 http://www.medworm.com/index.php?rid=3334089&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F2%2F194%3Frss%3D1 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 hea... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3334089 Thu, 04 Mar 2010 23:55:16 +0100 3334089 http://www.medworm.com/index.php?rid=3334088&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F2%2F173%3Frss%3D1 This study examines the consequences for medical specialists of participating in multidisciplinary medical team meetings in terms of perceived clinical autonomy, domain distinctiveness, and professional accountability. These consequences may influence their willingness to cooperate and the quality of teamwork. The authors hypothesized that multidisciplinary medical team meetings would be more of a threat to the professional identity of surgical specialists than to the professional identity of nonsurgical and supporting specialists. A survey among 1,827 Dutch medical specialists supported the authors’ hypotheses. However, a few specific specialties had response patterns that deviated from our expectations. The results are related to specialty choice, to the training of medical special... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3334088 Thu, 04 Mar 2010 23:55:16 +0100 3334088 http://www.medworm.com/index.php?rid=3334087&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F2%2F149%3Frss%3D1 This study consists of 36 key informant interviews that examined the experiences of nine IRFs in the lead-up to and aftermath of the IRF-PPS. Drawing on earlier work by Oliver, the authors develop a taxonomy of the new organizational practices that IRFs adopted in response to the changing payment system. A model of key organizational and environmental characteristics that predict the adoption of these practices based on an IRF’s willingness and/or capacity to comply with institutional pressure is then proposed. The proposed model can also be applied to other regulatory changes affecting IRFs. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3334087 Thu, 04 Mar 2010 23:55:16 +0100 3334087 http://www.medworm.com/index.php?rid=3334086&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F2%2F119%3Frss%3D1 Several initiatives promote patient involvement in error prevention, but little is known about its feasibility and effectiveness. A systematic review was conducted on the evidence of patients’ attitudes toward engagement in error prevention and the effectiveness of efforts to increase patient participation. Database searches yielded 3,840 candidate articles, of which 21 studies fulfilled the inclusion criteria. Patients share a positive attitude about engaging in their safety at a general level, but their intentions and actual behaviors vary considerably. Studies applied theories of planned behavior and indicate that self-efficacy, preventability of incidents, and effectiveness of actions seem to be central to patients’ intention to engage in error prevention. Rigorous evaluati... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3334086 Thu, 04 Mar 2010 23:55:16 +0100 3334086 http://www.medworm.com/index.php?rid=3128374&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F1%2F93%3Frss%3D1 In a cross-sectional observational study of Rochester (New York) primary care physicians (PCPs) enrolled in a pay-for-performance (P4P) collaboration, the authors investigated attitudinal factors associated with provider adherence to evidence-based clinical guidelines targeted by explicit incentives. The multivariable adherence model linked guideline adherence rates to provider attitudes among 186 survey respondents, adjusting for individual, practice, and community characteristics. Adherence was defined as the percentage of expected services that were delivered. Attitudes associated with adherence, independent of specialty and prior behavior, were financial salience (adjusted odds ratio [OR] = 3.6; 95% confidence interval [CI] = 1.7-8.4), peer cooperation (OR = 2.0; 95% CI = 1.0-4.0), con... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3128374 Tue, 29 Dec 2009 17:56:35 +0100 3128374 http://www.medworm.com/index.php?rid=3128373&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F1%2F74%3Frss%3D1 Using HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems, also known as the CAHPS Hospital Survey) data from 2,684 hospitals, the authors compare the experiences of Hispanic, African American, Asian/Pacific Islander, American Indian/Alaska Native, and multiracial inpatients with those of non-Hispanic White inpatients to understand the roles of between- and within-hospital differences in patients’ perspectives of hospital care. The study finds that, on average, non-Hispanic White inpatients receive care at hospitals that provide better experiences for all patients than the hospitals more often used by minority patients. Within hospitals, patient experiences are more similar by race/ethnicity, though some disparities do exist, especially for Asians. This research ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3128373 Tue, 29 Dec 2009 17:56:35 +0100 3128373 http://www.medworm.com/index.php?rid=3128372&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F1%2F56%3Frss%3D1 Prior research documents differences in patient-reported experiences by patient characteristics. Using nine measures of patient experience from 1,203,229 patients discharged in 2006-2007 from 2,684 acute and critical access hospitals, the authors find that adjusted hospital scores measure distinctions in quality for the average patient with high reliability. The authors also find that hospital "ranks" (the relative scores of hospitals for patients of a given type) vary substantially by patient health status and race/ ethnicity/language, and moderately by patient education and age (p < .05 for almost all measures). Quality improvement efforts should examine hospital performance with both sicker and healthier patients, because many hospitals that do well with one group (relative to other ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3128372 Tue, 29 Dec 2009 17:56:35 +0100 3128372 http://www.medworm.com/index.php?rid=3128371&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F1%2F38%3Frss%3D1 In this study, the authors jointly examine patient experience of care and clinical care measures from 2,583 hospitals based on inpatients discharged in 2006 and 2007. The authors use multinomial logistic regression to identify key characteristics of hospitals that perform in the top quartile on both, either, and neither dimension of quality. Top performers on both quality measures tend to be small (<100 beds), large (>200 beds) and rural, located in the New England or West North Central Census divisions, and nonprofit. Top performers in patient experience only are most often small and rural, located in the East South Central division, and government owned. Top performers in clinical care only are most often medium to large and urban, located in the West North Central division, and no... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3128371 Tue, 29 Dec 2009 17:56:35 +0100 3128371 http://www.medworm.com/index.php?rid=3128370&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F1%2F27%3Frss%3D1 The authors describe the history and development of the CAHPS Hospital Survey (also known as HCAHPS) and its associated protocols. The randomized mode experiment, vendor training, and "dry runs" that set the stage for initial public reporting are described. The rapid linkage of HCAHPS data to annual payment updates ("pay for reporting") is noted, which in turn led to the participation of approximately 3,900 general acute care hospitals (about 90% of all such United States hospitals). The authors highlight the opportunities afforded by this publicly reported data on hospital inpatients’ experiences and perceptions of care. These data, reported on www.hospitalcompare.hhs. gov, facilitate the national comparison of patients’ perspectives of hospital care and can be used alone or i... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3128370 Tue, 29 Dec 2009 17:56:35 +0100 3128370 http://www.medworm.com/index.php?rid=3128369&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F1%2F3%3Frss%3D1 Interprofessional approaches to health and social care have been linked to improved planning and policy development, more clinically effective services, and enhanced problem solving; however, there is evidence that professionals tend to operate in uniprofessional silos and that attempts to share knowledge across professional borders are often unsuccessful. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3128369 Tue, 29 Dec 2009 17:56:35 +0100 3128369 http://www.medworm.com/index.php?rid=2946178&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6_suppl%2F90S%3Frss%3D1 The aim of this systematic review was (a) to synthesize the evidence on the effectiveness of detection, mitigation, and actions to reduce risks in hospitals and (b) to identify and describe components of interventions responsible for effectiveness. Thirteen literature databases were explored using a structured search and data extraction strategy. All included studies dealing with incident reporting described positive effects. Evidence regarding the effectiveness and efficiency of safety analysis is scarce. No studies on mitigation were included. The collected evidence on risk reduction concerns a variety of interventions to reduce medication errors, fall incidents, diagnostic errors, and adverse events in general. Most studies reported positive effects; however, interventions were often mu... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946178 Fri, 30 Oct 2009 22:40:13 +0100 2946178 http://www.medworm.com/index.php?rid=2946177&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6_suppl%2F36S%3Frss%3D1 Health care is changing rapidly. Unacceptable variations in service access and quality of health care and pressures to contain costs have led to the redefinition of professional roles. The roles of nonphysician clinicians (nurses, physician assistants, and pharmacists) have been extended to the medical domain. It is expected that such revision of roles will improve health care effectiveness and efficiency. The evidence suggests that nonphysician clinicians working as substitutes or supplements for physicians in defined areas of care can maintain and often improve the quality of care and outcomes for patients. The effect on health care costs is mixed, with savings dependent on the context of care and specific nature of role revision. The evidence base underpinning these conclusions is stron... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946177 Fri, 30 Oct 2009 22:40:13 +0100 2946177 http://www.medworm.com/index.php?rid=2946176&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6_suppl%2F5S%3Frss%3D1 Health care is increasingly provided by teams of health professionals rather than by individual doctors. For decision makers, it is imperative to identify the critical elements for effective teams to transform health care workplaces into effective team-based environments. The authors reviewed the research literature published between 1990 and February 2008. The available research indicated that teams with enhanced clinical expertise improved professional performance and had mixed effects on patient outcomes. Teams with improved coordination had some positive effects on patient outcomes and limited effects on costs and resource utilization. The combination of enhanced expertise and coordination only showed some limited effect on patient outcomes. The authors conclude that enhancement of the... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946176 Fri, 30 Oct 2009 22:40:13 +0100 2946176 http://www.medworm.com/index.php?rid=2946175&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F66%2F6_suppl%2F3S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946175 Fri, 30 Oct 2009 22:40:13 +0100 2946175 http://www.medworm.com/index.php?rid=2946174&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6%2F725%3Frss%3D1 This study compares the compensation of nonprofit hospital CEOs in Ontario, Canada to the three longest reported and most used measures of hospital financial performance. Our sample consisted of 132 CEOs from 92 hospitals between 1999 and 2006. Unbalanced panel data were analyzed using fixed effects regression. Results suggest that CEO compensation was largely unrelated to hospital financial performance. Inflation-adjusted salaries appeared to increase over time independent of hospital performance, and hospital size was positively correlated with CEO compensation. The apparent upward trend in salary despite some declines in financial performance challenges the fundamental assumption underlying this article, that is, financial performance is likely linked to CEO compensation in Ontario. Fur... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946174 Fri, 30 Oct 2009 22:37:39 +0100 2946174 http://www.medworm.com/index.php?rid=2946173&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6%2F703%3Frss%3D1 The Institute of Medicine suggests redesigning health care to ensure safe, effective, timely, efficient, equitable, and patient-centered care. The concept of patient-centered access supports these goals. Group Health, a mixed-model health care system, attempted to improve patients’ access to care through the following changes: (a) offering a patient Web site with patient access to patient—physician secure e-mail, electronic medical records, and health promotion information; (b) offering advanced access to primary physicians; (c) redesigning primary care services to enhance care efficiency; (d) offering direct access to physician specialists; and (e) aligning primary physician compensation through incentives for patient satisfaction, productivity, and secure messaging with patie... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946173 Fri, 30 Oct 2009 22:37:39 +0100 2946173 http://www.medworm.com/index.php?rid=2946172&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6%2F682%3Frss%3D1 Using qualitative and quantitative methods, the authors develop and test hypotheses about the impact of hospitalists on efficiency and quality of care relative to teaching teams. Departure of actual from self-perceived benefits for hospitalists, both individually and collectively, is studied. It was found that hospitalists are, on average, more efficient diagnosticians and/or enhance throughput, as evidenced by having relatively lower charges, through reductions in testing and length-of-stay, than teaching teams. Much of that benefit is concentrated among patients admitted by intensivists. The authors find little evidence of quality focus or of greater use of community resources among hospitalists. Indeed, hospitalists were found to have no effect on the choice of postdischarge outlets. Th... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946172 Fri, 30 Oct 2009 22:37:39 +0100 2946172 http://www.medworm.com/index.php?rid=2946171&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6%2F658%3Frss%3D1 The authors develop a conceptual framework regarding how information technology (IT) can alter within-physician disparities, and they empirically test some of its implications in the context of coronary heart disease. Using a random experiment on 256 primary care physicians, the authors analyze the relationships between three IT functions (feedback and two types of clinical decision support) and five process-of-care measures. Endogeneity is addressed by eliminating unobserved patient characteristics with vignettes and by proxying for omitted physician characteristics. The results indicate that IT has no effects on physicians’ diagnostic certainty and treatment of vignette patients overall. The authors find that treatment and certainty differ by patient age, gender, and race. Consiste... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946171 Fri, 30 Oct 2009 22:37:39 +0100 2946171 http://www.medworm.com/index.php?rid=2946170&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6%2F639%3Frss%3D1 In this paper we use published information to analyze the economic value of Direct to Consumer Advertising (DTCA). The reviewed research finds that DTCA leads to increased demand for the advertised drug and that the effect of the drug tends to be class-wide rather than product specific. There is weak evidence that DTCA may increase compliance and improve clinical outcomes. However, there is little research on the effect of DTCA on inappropriate prescribing or on the characteristics of patients who respond to treatment. On net, if the advertised drugs are cost effective on average and the patients using the drugs in response to the advertisement are similar to other users, DTCA is likely cost effective. Overall, the literature to date is consistent with the idea that DTCA is beneficial, but... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946170 Fri, 30 Oct 2009 22:37:39 +0100 2946170 http://www.medworm.com/index.php?rid=2946169&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F6%2F611%3Frss%3D1 This review assessed the use of electronic medical record (EMR) systems in outcomes research. We systematically searched PubMed to identify articles published from January 2000 to January 2007 involving EMR use for outpatient-based outcomes research in the United States. EMR-based outcomes research studies (n = 126) have increased sixfold since 2000. Although chronic conditions were most common, EMRs were also used to study less common diseases, highlighting the EMRs’ flexibility to examine large cohorts as well as identify patients with rare diseases. Traditional multi-variate modeling techniques were the most commonly used technique to address confounding and potential selection bias. Data validation was a component in a quarter of studies, and many evaluated the EMR’s abilit... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2946169 Fri, 30 Oct 2009 22:37:39 +0100 2946169 http://www.medworm.com/index.php?rid=2777359&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F5%2F590%3Frss%3D1 A challenge to investigating quality of care at safety-net hospitals is the absence of a standard method for identifying these hospitals. The authors identified three different, commonly used approaches for classifying hospitals as safety-net providers. Analyzing national data on hospital demographics and quality of care, they found little overlap among these three sets of hospitals. Under two definitions, safety-net providers clearly underperformed on quality compared with non-safety-net providers; under a third definition, results were mixed. How one defines safety-net providers can affect health services research outcomes and policy recommendations. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2777359 Mon, 07 Sep 2009 23:00:00 +0100 2777359 http://www.medworm.com/index.php?rid=2777358&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F5%2F578%3Frss%3D1 We compared race disparities in health services use in a national sample of adults from the 2002 Medical Expenditure Panel Survey and data from the Exploring Health Disparities in Integrated Communities Project, a 2003 survey of adult residents from a low-income integrated urban community in Maryland. In the Medical Expenditure Panel Survey data, African Americans were less likely to have a health care visit compared with Whites. However, in the Exploring Health Disparities in Integrated Communities Project, the integrated community, African Americans were more likely to have a health care visit than Whites. The race disparities in the incidence rate of health care use among persons who had at least one visit were similar in both samples. Our findings suggest that disparities in health car... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2777358 Mon, 07 Sep 2009 23:00:00 +0100 2777358 http://www.medworm.com/index.php?rid=2777357&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F5%2F561%3Frss%3D1 This study hypothesizes that differences in health care access and utilization exist across Latino adults (>18 years), with U.S. Latino adults of Mexican ancestry demonstrating the worst patterns of access and utilization. The analyses use the National Health Interview Survey (NHIS) data from 1999 to 2007 (N = 33,908). The authors first estimate the disparities in health care access and utilization among different categories of Latinos. They also implement Blinder—Oaxaca techniques to decompose disparities into observed and unobserved components, comparing Latinos of Mexican ancestry with non-Mexican Latinos. Latinos of Mexican ancestry consistently demonstrate lower health care access and utilization patterns than non-Mexican Latinos. Health insurance and region of residence were... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2777357 Mon, 07 Sep 2009 23:00:00 +0100 2777357 http://www.medworm.com/index.php?rid=2777356&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F5%2F542%3Frss%3D1 We examined the relation of NCI cancer center attendance with 1- and 3-year all-cause and cancer-specific mortality using multilevel logistic regression models. NCI cancer center attendance was associated with a significant reduction in the odds of 1- and 3-year all-cause and cancer-specific mortality. The mortality risk reduction associated with NCI cancer center attendance was most apparent in late-stage cancers and was evident across all levels of comorbidities. Attendance at NCI cancer centers is associated with a significant survival benefit for the four major cancers among Medicare beneficiaries. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2777356 Mon, 07 Sep 2009 23:00:00 +0100 2777356 http://www.medworm.com/index.php?rid=2777355&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F5%2F522%3Frss%3D1 Mental illness stigma has been identified by national policy makers as an important barrier to help seeking for mental health. Using a random sample of 5,555 students from a diverse set of 13 universities, we conducted one of the first empirical studies of the association of help-seeking behavior with both perceived public stigma and people’s own stigmatizing attitudes (personal stigma). There were three main findings: (a) Perceived public stigma was considerably higher than personal stigma; (b) personal stigma was higher among students with any of the following characteristics: male, younger, Asian, international, more religious, or from a poor family; and (c) personal stigma was significantly and negatively associated with measures of help seeking (perceived need and use of psychot... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2777355 Mon, 07 Sep 2009 23:00:00 +0100 2777355 http://www.medworm.com/index.php?rid=2777354&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F5%2F491%3Frss%3D1 A growing body of evidence documents pervasive racial, ethnic, and class disparities in long-term care in the United States. At the same time, major quality improvement initiatives are being implemented that rely on market-based incentives, many of which may have the unintended consequence of exacerbating disparities. We review existing evidence on disparities in the use and quality of long-term care services, analyze current market-based policy initiatives in terms of their potential to ameliorate or exacerbate these disparities, and suggest policies and policy modifications that may help decrease disparities. We find that racial disparities in the use of formal long-term care have decreased over time. Disparities in quality of care are more consistently documented and appear to be relate... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2777354 Mon, 07 Sep 2009 23:00:00 +0100 2777354 http://www.medworm.com/index.php?rid=2583243&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F4%2F472%3Frss%3D1 This study wanted to challenge these perceptions by disaggregating IMGs by immigration and citizenship status to carefully examine their numerical levels and choices in training specialty and location during a 10-year period. The results demonstrate a shrinking IMG population overall for the state of New York, with noncitizen IMGs shrinking the most markedly. This may bear heavily on New York's physician supply and distribution, particularly for underserved locales. The authors find evidence consistent with some degree of substitution in favor of native-born and naturalized IMGs versus noncitizen IMGs. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2583243 Tue, 07 Jul 2009 23:00:00 +0100 2583243 http://www.medworm.com/index.php?rid=2583242&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F4%2F456%3Frss%3D1 Data from the 2005 Medical Expenditure Panel Survey were used to conduct a disaggregated comparison of utilization and expenditures under Medicaid and private health insurance for low-income adults and children. After adjustment for health status and other factors, Medicaid adults and children had greater use of prescription drugs than the privately insured, but there were no significant differences in prescription expenditures. Adults on Medicaid had lower utilization of office-based medical and dental care and much lower expenditures than the privately insured. Contrary to stereotypes, there were no significant differences between Medicaid adults and children and the privately insured in emergency, outpatient, or inpatient hospital use, and the former had significantly lower expenditures... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2583242 Tue, 07 Jul 2009 23:00:00 +0100 2583242 http://www.medworm.com/index.php?rid=2583241&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F4%2F436%3Frss%3D1 The Institute of Medicine report, Unequal Treatment, asserts that conscious and unconscious bias of providers may affect treatments delivered and contribute to health disparities. The primary study objective is to measure, compare, and contrast objective and subjective cognitive processes among pharmacy, nursing, and medical students to discern potential implications for health disparities. Data were collected using a cultural competency questionnaire and two implicit association tests (IATs). Race and skin tone IATs measure unconscious bias. Cultural competency scores were significantly higher for non-Hispanic Blacks and Hispanics in medicine and pharmacy compared with non-Hispanic Whites. Multiracial nursing students also had significantly higher cultural competency scores than non-Hispa... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2583241 Tue, 07 Jul 2009 23:00:00 +0100 2583241 http://www.medworm.com/index.php?rid=2583240&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F4%2F409%3Frss%3D1 This study investigates differences in the effects of comorbidities on survival in Medicare beneficiaries with prostate cancer. Medicare data were used to assemble a cohort of 65- to 76-year-old Black (n = 6,402) and White (n = 47,458) men with incident localized prostate cancer in 1999 who survived ≥1 year postdiagnosis. Comorbidities were more prevalent among Blacks than among Whites. For both races, greater comorbidity was associated with decreasing survival rates; however, the effect among Blacks was smaller than in Whites. After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comorbidit... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2583240 Tue, 07 Jul 2009 23:00:00 +0100 2583240 http://www.medworm.com/index.php?rid=2583239&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F4%2F355%3Frss%3D1 Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% quality, and 6% cost. Noncitizens and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born. The foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination. Immigrants incurred lower costs than the U.S. born, except emergency department expenditures for immigrant children. Policy solutions are needed to improve health care for immig... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2583239 Tue, 07 Jul 2009 23:00:00 +0100 2583239 http://www.medworm.com/index.php?rid=2385903&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F3%2F339%3Frss%3D1 This article describes the services offered by RBMs and then presents trends in utilization of advanced imaging procedures from three health plans that adopted RBM prior authorization protocols. The implementation of prior authorization protocols by each plan was associated with declines in use of advanced imaging procedures, especially during the first year of the program. Although more rigorous empirical analysis is required in order to draw definitive conclusions, these trends suggest that RBM prior authorization initiatives may be a viable approach for addressing concerns about appropriate use of advanced imaging. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2385903 Fri, 01 May 2009 04:00:00 +0100 2385903 http://www.medworm.com/index.php?rid=2385902&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F3%2F320%3Frss%3D1 This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety c... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2385902 Fri, 01 May 2009 04:00:00 +0100 2385902 http://www.medworm.com/index.php?rid=2385901&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F3%2F307%3Frss%3D1 We examined registered nurse (RN) staffing from 1997 to 2004 in ten states in which there was considerable SSH entry during this period. Regression estimates used longitudinal panel data models with hospital fixed effects to compare changes in numbers of RNs in general hospitals located in markets with SSHs with general hospitals located in markets where there were no SSHs. Results indicate that hospitals located in markets with orthopedic/surgical SSH presence raised their RN nurse staffing levels. Whether or not these changes are associated with improved patient outcomes is unknown. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2385901 Fri, 01 May 2009 04:00:00 +0100 2385901 http://www.medworm.com/index.php?rid=2385900&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F3%2F272%3Frss%3D1 There is a growing interest in community-level characteristics such as social capital and its relationship to health care access. To assess the rigor with which this construct has been empirically applied in research on health care access, a systematic review was conducted. A total of 2,396 abstracts were reviewed, and 21 met the criteria of examining some measure of social capital and its effects on health care access. The review found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on health care access. Insights from the social network literature can help improve the conceptual and measurement problems. Future work should distinguish among... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2385900 Fri, 01 May 2009 04:00:00 +0100 2385900 http://www.medworm.com/index.php?rid=2385899&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F3%2F235%3Frss%3D1 This article presents a systematic review of the research methods used to study quality improvement (QI) effectiveness in health care organizations. The review relied on existing literature as well as emergent themes to identify types of QI programs (e.g., data/feedback, information technology, staff education) and quality outcomes (e.g., mortality, morbidity, unnecessary variation). Studies were separated into four categories according to the type of organization in which the QI program was introduced: (a) hospital, (b) nursing home, (c) physician group, and (d) other health care organization. Results of the review indicate that most QI effectiveness research is conducted in hospital settings, is focused on multiple QI interventions, and utilizes process measures as outcomes. The review a... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2385899 Fri, 01 May 2009 04:00:00 +0100 2385899 http://www.medworm.com/index.php?rid=2363140&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F2%2F713%3Frss%3D1 In the April 2009 issue of Medical Care Research and Review there was a mistake in Figure 1 on page 139. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2363140 Fri, 24 Apr 2009 04:00:00 +0100 2363140 http://www.medworm.com/index.php?rid=2237660&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F2%2F219%3Frss%3D1 Disparities in access to and quality of health care along racial and ethnic lines are an important national problem. Health care purchasers and payers have a potentially important role to play in alleviating this problem. Using national surveys of 609 employers and 252 health plans with HMO products in 41 U.S. markets, we examined awareness of racial and ethnic disparities in health care access and quality, perceptions of employer and health plan role in addressing disparities, and reported efforts to measure and reduce disparities. Our findings suggest that most health plans and many employers are aware of the existence of substantial disparities and that health plans, but not employers, have taken steps to examine and influence patterns of care by race and ethnicity among their members. ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237660 Wed, 04 Mar 2009 05:00:00 +0100 2237660 http://www.medworm.com/index.php?rid=2237659&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F2%2F197%3Frss%3D1 The relationship between higher procedure volumes and medical outcomes has generated recommendations for greater use of high-volume hospitals, with research and advocacy on this issue intensifying during the 1990s. Despite this interest, the trends presented here showed only limited changes between 1995 and 2002. For a number of services, less than half of patients received care at high-volume hospitals, and for several services, there was a surprising decline in the proportion at high-volume hospitals. Trends in the rate of high-volume hospital use appeared to be associated with trends in aggregate volume, at the same time that there were only modest changes in either patient use of high-volume hospitals or the number of hospitals offering these services. These trends suggested the import... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237659 Wed, 04 Mar 2009 05:00:00 +0100 2237659 http://www.medworm.com/index.php?rid=2237658&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F2%2F181%3Frss%3D1 Despite the legal and practical importance of monitoring and oversight of management by hospital governing boards, there is little empirical evidence of how hospital boards fulfill these roles and the extent to which these practices have changed over time. We utilize data from three national surveys of hospital governance to examine how oversight and monitoring practices in public and private not-for-profit (NFP) hospital boards have changed over time. Findings suggest that board relations with CEOs in NFP hospitals display important but potentially contradictory patterns. On the one hand, NFP hospital boards appear to be exercising more stringent oversight of management and hospital performance. On the other hand, management is more actively involved with governance matters with less sepa... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237658 Wed, 04 Mar 2009 05:00:00 +0100 2237658 http://www.medworm.com/index.php?rid=2237657&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F2%2F167%3Frss%3D1 The privately insured are assuming a greater share of the costs of their health care, yet little is known about changes in out-of-pocket spending at the state level. The central problem is that national surveys with the relevant data are not designed to generate state-level estimates. The study addresses this shortcoming by using a two-sample modeling approach to estimate state-level measures of out-of-pocket spending relative to income for privately insured adults and children. National data from the Medical Expenditure Panel Survey—Household Component and state representative data from the from the Current Population Survey are used. Variation in out-of-pocket spending over time and across states is shown, highlighting concern about the adequacy of coverage for 2.9% of privately in... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237657 Wed, 04 Mar 2009 05:00:00 +0100 2237657 http://www.medworm.com/index.php?rid=2237656&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F2%2F147%3Frss%3D1 As health care systems seek to provide patient-centered care as a cornerstone of quality, how to measure this aspect of quality has become a concern. Previous development of quality indicators for treating individual chronic disease has rarely included patient perspectives on quality of care. Using epilepsy as an exemplar, the authors sought to develop an approach to measuring patient-centered quality of care. They conducted six focus groups with adults with epilepsy. Using qualitative methods, the authors initially identified 10 patient-generated quality indicators, 5 of which were subsequently rated, along with literature-based quality indicators, by an expert panel using a modified RAND appropriateness methodology. The authors discuss similarities and differences in aspects of care pati... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237656 Wed, 04 Mar 2009 05:00:00 +0100 2237656 http://www.medworm.com/index.php?rid=2237655&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F2%2F119%3Frss%3D1 This article presents a literature review and synthesis of 10 trials targeted on older adults with disability. The review is organized into structure and process components related to the outcome variable disability based on the classic Donabedian model. The review suggests that the components of in-home visiting associated with favorable disability outcomes include multiple home visits, geriatric training and experience, health provider collaboration, multidimensional assessment, and theory use. In contrast, lack of process measures, physician collaboration, training, and specific intervention components targeting disability are associated with ineffective interventions. This review helps provide insight into variables that influence disability outcomes as well as the development of best-... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237655 Wed, 04 Mar 2009 05:00:00 +0100 2237655 http://www.medworm.com/index.php?rid=2237665&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1_suppl%2F75S%3Frss%3D1 American health care is complex, fragmented, and arcane rather than being patient centered. Many patients have considerable difficulty navigating this system. As a result, care is less timely, safe, effective, and efficient. Since navigation problems are more likely for those who are sicker and less educated, they contribute to inequity. Early solutions proposed for this problem focused on the use of yet another specialized professional, the "navigator," to help individuals find their way through the system so they get the care they need. The author defines the patient navigation problem and its probable consequences and argues that research and action are needed to (a) document the problem empirically, (b) identify underlying organizational structures and behaviors that can make navigatio... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237665 Tue, 30 Dec 2008 05:00:00 +0100 2237665 http://www.medworm.com/index.php?rid=2237664&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1_suppl%2F53S%3Frss%3D1 There is considerable evidence, across different clinical contexts, that treatment decisions are characterized by poor communication, significant knowledge gaps, and a lack of attention to patients' preferences for different health states. Over the past two decades, patient decision aids have been shown to be an effective means to improve the quality of decisions. More recently, the Internet has increased expectations about the impact of information and decision aids on the involvement of patients in decisions. However, there are several challenges to effective dissemination and implementation of decision support interventions, through the Internet or other media. The authors recommend specific policy and research initiatives to facilitate the local and system-level changes necessary to su... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237664 Tue, 30 Dec 2008 05:00:00 +0100 2237664 http://www.medworm.com/index.php?rid=2237663&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1_suppl%2F28S%3Frss%3D1 This article reviews the literature relating quality to consumer choice of health plan or health care provider. Evidence suggests that consumers tend to choose better performing health plans and providers and are responsive to initiatives that provide quality information. The response to quality and quality information differs significantly among consumers and across population subgroups. As such the effect of quality information on choice is apparent in only a relatively small, though perhaps consequential, number of consumers. Despite the wealth of findings on the topic to date, the authors suggest directions for future work, including better assessment of the dynamic issues related to information release, as well as a better understanding of how the response to information varies across... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237663 Tue, 30 Dec 2008 05:00:00 +0100 2237663 http://www.medworm.com/index.php?rid=2237662&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1_suppl%2F9S%3Frss%3D1 Current policy directions place high expectations on consumers, pressing them to adopt new roles and behaviors. The price of failing to meet these expectations will be high for the individual, for the care delivery system, and for the society as a whole. Yet there is limited support in place to help consumers meet these expectations. The article reviews the major approaches used to stimulate consumer engagement in health and health care. The concept of activation is explored as a possible organizing construct for informing strategies to increase consumer involvement in health. Illustrative data are presented that show how activation levels are associated with engaging in specific health behaviors. The strategy of measuring activation and calibrating both the type and the amount of support ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237662 Tue, 30 Dec 2008 05:00:00 +0100 2237662 http://www.medworm.com/index.php?rid=2237661&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F66%2F1_suppl%2F3S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2237661 Tue, 30 Dec 2008 05:00:00 +0100 2237661 http://www.medworm.com/index.php?rid=2070267&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1%2F97%3Frss%3D1 Evidence suggests that Medicare Part D plan ownership is "sticky"; beneficiaries are unlikely to change plans from year to year, even when it would be in their financial interest to do so. The complexity of the program may contribute to this problem. Using data from a national survey, the authors examine the characteristics of those who believe that Part D is too complicated as well as the characteristics of those who endorse one of two policies to simplify the program. The results indicate that a great majority of adults believe that the program is too complicated and most favor some form of simplification. In multivariate analyses, one of the most consistent predictors is political orientation. Republicans are significantly less likely to think that Part D is too complicated, and liberal... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070267 Tue, 30 Dec 2008 05:00:00 +0100 2070267 http://www.medworm.com/index.php?rid=2070266&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1%2F82%3Frss%3D1 The purpose of this study is to examine the manner in which Super User attitudes toward clinical information systems (CIS) are associated with employee experiences with CIS implementation. Super Users (N = 82), selected by hospital administration to assist in implementation of the new CIS, completed a survey that assessed time spent in the Super User role as well as attitudes toward the role. These data were matched with hospital employee (N = 325) survey data about attitudes toward CIS and its impact on work processes. Time spent in the role of Super User was associated with employee attitudes; Super Users' perceptions about qualifications also predicted employee attitudes, particularly about care outcomes and perceptions about implementation of the CIS. The study suggests that as organiz... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070266 Tue, 30 Dec 2008 05:00:00 +0100 2070266 http://www.medworm.com/index.php?rid=2070265&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1%2F68%3Frss%3D1 Despite widening efforts to publicly report health care quality data, patients appear to make little use of these data. Several studies indicate patients' interest in physician-level information, but actual use of physician-level data remains unestablished. Using a randomized experimental design, this study evaluates the extent to which use of a Web site offering physician-level data is affected by three parameters: invitation mode (mail vs. e-mail), employment status (employed vs. retired), and invitation message tone (risk- vs. gain-focused). The results find significantly higher use among those invited by e-mail (p < .001) and among retired adults (p < .001). Message tone is not significantly associated with use rates, but a borderline significant result suggests that high-risk me... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070265 Tue, 30 Dec 2008 05:00:00 +0100 2070265 http://www.medworm.com/index.php?rid=2070264&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1%2F49%3Frss%3D1 A large literature examines the effects of health insurance on the health care utilization of children; however, most existing studies conceptualize coverage as a point-in-time measure rather than as a dynamic phenomenon. The major contribution of this article is its provision of estimates on the relationship between the duration of coverage over the course of a calendar year and health care utilization among children. Using child-level fixed-effects regression, we find that an incremental uninsured month is associated with a 0.7 percentage point decline in the probability of receiving a visit over the course of a year and a 3% decrease in the number of visits received. Children with intrayear coverage losses are more likely than those with continuous coverage to lose their usual source of... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070264 Tue, 30 Dec 2008 05:00:00 +0100 2070264 http://www.medworm.com/index.php?rid=2070263&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1%2F23%3Frss%3D1 This study used data from the 1996-2005 Medical Expenditure Panel Survey (MEPS) to compare trends in disparities by three definitions of racial/ethnic disparities and to assess the influence of changes in socioeconomic status (SES) among racial/ethnic minorities on disparity trends. This study prefers the Institute of Medicine's (IOM) definition, which adjusts for health status but allows for mediation of racial/ethnic disparities through SES factors. Black—White disparities in having an office-based or outpatient visit and medical expenditure were roughly constant and Hispanic—White disparities increased for office-based or outpatient visits and for medical expenditure between 1996-1997 and 2004-2005. Estimates based on the independent effect of race/ethnicity were the most co... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070263 Tue, 30 Dec 2008 05:00:00 +0100 2070263 http://www.medworm.com/index.php?rid=2070262&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F66%2F1%2F3%3Frss%3D1 Large cost variations of liver transplantation are reported. The aim of this study was to assess cost differences of liver transplantation and clinical follow-up between the United States and other Organization for Economic Cooperation and Development (OECD) countries. Eight electronic databases were searched, and 2,000 citations published after 1990 with more than 10 transplantations, and with original cost data, were identified. A total of 30 articles included 5,975 liver transplantations. Meta-analysis was used to derive a combined mean using a random-effects model to test for heterogeneity between studies. Estimated mean cost of a U.S. liver transplantation was US$163,438 (US$145,277-181,598) compared to US$103,548 (US$85,514-121,582) for other OECD countries. Patient characteristics, ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070262 Tue, 30 Dec 2008 05:00:00 +0100 2070262 http://www.medworm.com/index.php?rid=2070271&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6_suppl%2F79S%3Frss%3D1 Increased interest in health care consumerism has created an environment conducive to growth in the use of decision aids (DAs) to support patient decision making. The authors review the research literature published within the past 5 years that assesses the effects of DAs in the areas of screening and treatment. Multiple measures are used to evaluate the effectiveness of DAs, with mixed evidence of impacts. To date, most evidence from screening studies suggests that DAs are effective in increasing knowledge and are acceptable to patients, but patient uptake of screening has been mixed. Among treatment studies, there is some, but limited, evidence showing impact of DAs on immediate and long-term decisional conflict, patient satisfaction, and quality of life. Few studies provide assessment o... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070271 Mon, 17 Nov 2008 05:00:00 +0100 2070271 http://www.medworm.com/index.php?rid=2070270&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6_suppl%2F36S%3Frss%3D1 Over the past decade, there has been a substantial increase in the use of financial incentives by private employers and public programs to encourage healthy behaviors, wellness activities, and use of preventive services. The research evidence regarding the effectiveness of this approach is reviewed, summarizing relevant findings from literature reviews and from recent evaluations. The article concludes that financial incentives, even relatively small incentives, can influence individuals' health-related behaviors. However, the findings regarding health promotion and wellness are based primarily on analyses of a limited number of private sector initiatives, whereas the evidence regarding preventive services is based on evaluations of initiatives sponsored predominantly by public programs an... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070270 Mon, 17 Nov 2008 05:00:00 +0100 2070270 http://www.medworm.com/index.php?rid=2070269&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6_suppl%2F5S%3Frss%3D1 There has been a growing interest in the use of financial incentives to encourage improvements in the quality of health care. Several articles have reviewed past studies of the impact of specific incentive arrangements, but these studies addressed small-scale experiments, making their findings arguably of limited relevance to current improvement efforts. In this article, the authors review evaluations of more recent pay-for-performance initiatives instituted by health plans or by provider organizations in cooperation with health plans. Findings show improvement in selected quality measures in most of these initiatives, but the contribution of financial incentives to that improvement is not clear; the incentives typically were implemented in conjunction with other quality improvement effort... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070269 Mon, 17 Nov 2008 05:00:00 +0100 2070269 http://www.medworm.com/index.php?rid=2070268&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F65%2F6_suppl%2F3S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=2070268 Mon, 17 Nov 2008 05:00:00 +0100 2070268 http://www.medworm.com/index.php?rid=1966952&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F65%2F6%2F764%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966952 Mon, 17 Nov 2008 05:00:00 +0100 1966952 http://www.medworm.com/index.php?rid=1966951&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F65%2F6%2F763%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966951 Mon, 17 Nov 2008 05:00:00 +0100 1966951 http://www.medworm.com/index.php?rid=1966950&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6%2F748%3Frss%3D1 This article discusses the influence of family structure on children's use of mental health services and explores whether a family's dependency on government assistance compensates for the effect of family income on children's use of services. Children in nontraditional families are at greater risk of using mental health services and have more mental health visits. Family participation in government subsidies programs offsets the influence of family income on the use of mental health services. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966950 Mon, 17 Nov 2008 05:00:00 +0100 1966950 http://www.medworm.com/index.php?rid=1966949&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6%2F729%3Frss%3D1 This study uses resource dependence theory to examine how the concentration of client referrals into outpatient substance abuse treatment may affect treatment comprehensiveness. Data were from the 1995, 1999/2000, and 2005 waves of a national longitudinal survey. Results from generalized estimating equation models (sample sizes from 1,350 to 1,375) indicate that more concentrated referral sources were negatively associated with three of the four indicators of treatment comprehensiveness: the percentages of clients receiving routine medical care, mental health care, and financial counseling. Substance abuse treatment programs may be focusing their treatment practices to meet the demands of key referral sources. Given the importance of comprehensive treatment for substance abusing clients, h... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966949 Mon, 17 Nov 2008 05:00:00 +0100 1966949 http://www.medworm.com/index.php?rid=1966948&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6%2F713%3Frss%3D1 Physicians, health plans, and health systems are increasingly evaluated and rewarded based on Health Plan Effectiveness Data and Information Set (HEDIS) and HEDIS-like performance measures. Concurrently, employers and health plans continue to try to control expenditures by increasing out-of-pocket costs for patients. The authors use fixed-effect logit models to assess how rising copayment rates for physician office visits and prescription drugs affect performance on HEDIS measures. Findings suggest that the increase in copayment rates lowers performance scores, demonstrating the connection between financial aspects of plan design and quality performance, and highlighting the potential weakness of holding plans and providers responsible for performance when payers and benefit plan managers ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966948 Mon, 17 Nov 2008 05:00:00 +0100 1966948 http://www.medworm.com/index.php?rid=1966947&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6%2F696%3Frss%3D1 The authors developed and empirically tested a model reflecting a system of interrelations among patient loyalty, trust, and satisfaction as they are related to patients' intentions to stay with a primary care physician (PCP) and recommend the doctor to other people. They used a structural equation modeling approach. The fit statistics indicate a well-fitting model: root mean square error of approximation = .022, goodness-of-fit index = .99, adjusted goodness-of-fit index = .96, and comparative fit index = 1.00. The authors found that patient trust and good interpersonal relationships with the PCP are major predictors of patient satisfaction and loyalty to the physician. Patients need to trust the PCP to be satisfied and loyal to the physician. The authors also found that patient trust, sa... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966947 Mon, 17 Nov 2008 05:00:00 +0100 1966947 http://www.medworm.com/index.php?rid=1966946&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6%2F674%3Frss%3D1 In conclusion, quality of care varies among primary care physicians and appears to be associated with physician characteristics to a greater extent than patient characteristics. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966946 Mon, 17 Nov 2008 05:00:00 +0100 1966946 http://www.medworm.com/index.php?rid=1966945&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F6%2F655%3Frss%3D1 This article describes physicians' responses to patient questions and physicians' views about public reports on hospital quality. Interviews with 56 office-based physicians in seven states/regions used hypothetical scenarios of patients questioning referrals based on public reports of hospital quality. Responses were analyzed using an iterative coding process to develop categories and themes from data. Four themes describe physicians' responses to patients: (a) rely on existing physician—patient relationships, (b) acknowledge and consider patient perspectives, (c) take actions to follow up on patient concerns, and (d) provide patients' perspectives on quality reports. Three themes summarize responses to hospital quality reports: perceived lack of methodological rigor, content conside... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1966945 Mon, 17 Nov 2008 05:00:00 +0100 1966945 http://www.medworm.com/index.php?rid=1787675&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F65%2F5%2F649%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787675 Fri, 12 Sep 2008 04:00:00 +0100 1787675 http://www.medworm.com/index.php?rid=1787674&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F5%2F638%3Frss%3D1 Managed care is now the norm for many on Medicaid, with approximately 19 million people on Medicaid enrolled in health maintenance organizations. In 2005, nearly 300 plans nationwide participated in state Medicaid managed care programs, with many of those plans operating under for-profit ownership. Concerns about the impact of plan ownership on access to care arise because of differences in the incentives in place in for-profit and nonprofit organizations that may lead for-profit plans to restrict access to care. Using data from the 2002 National Survey of America's Families on plan enrollment for a national sample of Medicaid enrollees, this study examines the link between for-profit plan ownership and enrollees' access to health care. The results suggest that access to care for Medicaid ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787674 Fri, 12 Sep 2008 04:00:00 +0100 1787674 http://www.medworm.com/index.php?rid=1787673&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F5%2F617%3Frss%3D1 The authors examine trends over 1997-2001 in racial or ethnic disparities in the utilization of three costly, referral-sensitive procedures among the elderly—coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), and hip/joint replacement. Using a multivariate framework, they undertake a simultaneous examination of the relationships between patient, local area context, and health systems on these admission types after comparing them to a control group. This period spans the implementation of the Balanced Budget Act and a major Department of Health and Human Services initiative to reduce disparities in cardiovascular and other diseases. Findings suggest increasing disparities for African Americans relative to Whites in their lower utilization of... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787673 Fri, 12 Sep 2008 04:00:00 +0100 1787673 http://www.medworm.com/index.php?rid=1787672&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F5%2F596%3Frss%3D1 This study examined effects of race and insurance on the risk of potentially avoidable hospitalizations (PAHs) in Tennessee. Applying the current Agency for Healthcare Research and Quality definitions for ambulatory-care-sensitive conditions to inpatient discharge data, the study found hospitalized Black patients more likely than their White counterparts to have experienced a PAH for chronic conditions. In contrast, Black inpatients' risk was lower than that of White inpatients for acute conditions after controlling for covariates. The results also showed the strong influence of insurance coverage. Finally, an analysis of racial differences in the relative risks for PAHs using data grouped by insurance status showed that hospitalized Blacks within each subset had a greater risk of having a... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787672 Fri, 12 Sep 2008 04:00:00 +0100 1787672 http://www.medworm.com/index.php?rid=1787671&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F5%2F571%3Frss%3D1 Five years after the Institute of Medicine (IOM) called for a redesigned U.S. health care system, relatively little was known about the extent to which hospitals had undertaken quality improvement (QI) efforts to address deficiencies in patient care. To examine the state of hospital QI activities in 2006, the authors designed and conducted a survey of short-term, general hospitals with 25 or more beds. In a sample of 470 hospitals, they found that many were actively engaged in improvement efforts but that these activities varied in method and impact. Hospitals with high levels of perceived quality, as reflected in assessments by their quality managers, were more likely to have embraced QI as a strategic priority, employed quality practices and processes consistent with IOM aims, fostered s... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787671 Fri, 12 Sep 2008 04:00:00 +0100 1787671 http://www.medworm.com/index.php?rid=1787670&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F5%2F564%3Frss%3D1 Why do we need "public policy" regarding specialty hospitals? What is the rationale for government involvement in decisions by the private sector to invest in specialty hospitals? Two possibilities are reduced access to services primarily by the uninsured (a fairness concern) and changes in the types of patients receiving care resulting from poor consumer information (an efficiency concern). The fairness argument faces logical and empirical difficulties, and even if it proved to be true, it is not clear that limiting the growth of specialty hospitals would be an efficient way to address the problem. However, there is some empirical evidence to support the efficiency concern, and if specialty hospitals result in the treatment of patients with lower expected net benefits from treatment, then... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787670 Fri, 12 Sep 2008 04:00:00 +0100 1787670 http://www.medworm.com/index.php?rid=1787669&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F5%2F554%3Frss%3D1 There are two major aims of this commentary on "The Economics of Specialty Hospitals" by Schneider and colleagues (this issue). The first aim is to identify and discuss the policy, market, and organizational context in which physician-owned specialty hospitals have emerged and now exist in the United States. This context is critical for understanding aspects of the economic model and the potential advantages and disadvantages of physician-owned specialty (or limited-service) hospitals relative to general (or full-service) hospitals now and over time. The second aim is to discuss the six specific elements of the model (i.e., consumer demand, procedural operating margins, clinical efficiencies, procedural economies of scale, economies or diseconomies of scope, and competencies and learning).... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787669 Fri, 12 Sep 2008 04:00:00 +0100 1787669 http://www.medworm.com/index.php?rid=1787668&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F5%2F531%3Frss%3D1 This article reviews existing literature, reports, and findings from site visits to explore the economic rationale for specialty hospitals. The discussion focuses on six factors associated with specialization: consumer demand, procedural operating margins, clinical efficiencies, procedural economies of scale, economies (and diseconomies) of scope, and competencies and learning. A better understanding of the economics of specialization will help policy makers evaluate the full spectrum of advantages and disadvantages of specialty hospitals. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1787668 Fri, 12 Sep 2008 04:00:00 +0100 1787668 http://www.medworm.com/index.php?rid=1633786&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F4%2F514%3Frss%3D1 In the context of recent state budget shortfalls and the repeal of the Boren Amendment, state Medicaid expenditures for nursing home care were considered a potential target for payment cuts. The authors examine this issue using data from a survey of state nursing home payment policies. Results indicate that aggregate inflation-adjusted Medicaid payment rates steadily increased through 2004, and this growth is partly attributable to the adoption of nursing home provider taxes in many states. A recent proposal to cap provider taxes, if enacted, may lead to a decrease in Medicaid payment rates for nursing home care. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1633786 Thu, 17 Jul 2008 04:00:00 +0100 1633786 http://www.medworm.com/index.php?rid=1633785&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F4%2F496%3Frss%3D1 This study investigates how hospital electronic medical record (EMR) use influences quality performance. Data include nonfederal acute care hospitals in the United States. Sources of the data include the American Hospital Association, Hospital Quality Alliance, the Healthcare Information and Management Systems Society, and the Centers for Medicare and Medicaid Services case-mix index sets. The authors use a retrospective cross-sectional format with linear regression to assess the relationship between hospital EMR use and quality performance. Quality performance is measured using 10 process indicators related to 3 clinical conditions: acute myocardial infarction, congestive heart failure, and pneumonia. The authors also use a propensity score adjustment to control for possible selection bia... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1633785 Thu, 17 Jul 2008 04:00:00 +0100 1633785 http://www.medworm.com/index.php?rid=1633784&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F4%2F478%3Frss%3D1 The objective of this article is to develop measures to guide analysis and policy for urban safety-net hospitals. The authors developed three safety-net measures: the socioeconomic status of hospital service area, Medicaid intensity, and uncompensated care burden and its market share. Cluster analysis was used to identify break points that distinguish a safety-net hospital from a non-safety-net hospital. The measures developed were stable and independent, but a data-driven binary assignment of hospitals to a "safety-net" category was not supported. These analyses call into question the empirical basis for distinguishing a specific group of hospitals as safety-net hospitals. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1633784 Thu, 17 Jul 2008 04:00:00 +0100 1633784 http://www.medworm.com/index.php?rid=1633783&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F4%2F450%3Frss%3D1 While a lack of health insurance or interrupted coverage has been shown to lead to poorer health status among preretirement populations, this phenomenon has not been examined among a large population of younger, working-age adults. We analyzed a nationally representative data set of persons born between 1957 and 1961, the National Longitudinal Survey of Youth—1979, to examine the links between insurance continuity and self-assessed physical and mental health at age 40. Among respondents turning 40 in 1998 or 2000, 59.8% had been continuously insured during the decade before they reached age 40. In unadjusted analysis, persons who were continuously covered had the highest scores for both physical and mental health. After controlling for respondent characteristics, insurance coverage w... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1633783 Thu, 17 Jul 2008 04:00:00 +0100 1633783 http://www.medworm.com/index.php?rid=1633782&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F4%2F437%3Frss%3D1 In this study, the authors explore whether patterns of utilization change after enrollment in a CDHP and whether the pattern reflects a shift toward evidence-based care. The study population is comprised of 18,025 employees and their adult dependents. The analysis uses a schema for categorizing claims data into high-priority (evidence-based care) and low-priority (limited or no evidence-based care) utilization. The findings indicate that enrollment in CDHPs resulted in a reduction of office visits in the 1st year of enrollment. These reductions in care appear to be indiscriminant, with patients cutting back in both high-and low-priority visits. The reductions in high- and low-priority visits were greater for employees with lower education and income. (Source: Medical Care Research and Revi... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1633782 Thu, 17 Jul 2008 04:00:00 +0100 1633782 http://www.medworm.com/index.php?rid=1633781&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F4%2F379%3Frss%3D1 This article assesses how organizational readiness for change has been defined and measured in health services research and other fields. Analysis of 106 peer-reviewed articles reveals conceptual ambiguities and disagreements in current thinking and writing about organizational readiness for change. Inspection of 43 instruments for measuring organizational readiness for change reveals limited evidence of reliability or validity for most publicly available measures. Several conceptual and methodological issues that need to be addressed to generate knowledge useful for practice are identified and discussed. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1633781 Thu, 17 Jul 2008 04:00:00 +0100 1633781 http://www.medworm.com/index.php?rid=1435540&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F3%2F356%3Frss%3D1 The authors use variation across states and over time in managed care (MC) programs for publicly insured children to examine whether effects differ for children with chronic health conditions (CWCHC) and those without. The authors pool data from the 1997 to 2002 National Health Interview Survey and link county, year, and health status information on type of MC programs implemented. Findings show that the effects of MC are concentrated on CWCHC and that CWCHC experience reductions in use of specialist, mental health, and prescription drugs. Capitated programs with mental health or specialty carve-outs are associated with a greater number and larger decreases in service use compared to integrated capitated programs. While it is not possible to determine whether MC programs resulted in more a... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1435540 Mon, 12 May 2008 04:00:00 +0100 1435540 http://www.medworm.com/index.php?rid=1435539&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F3%2F338%3Frss%3D1 States' use of Medicaid 1915(c) waiver services for persons living with HIV/AIDS (PLWHA) has been limited. The authors examine state-level factors related to the decision to offer waiver services, as well as waiver use and expenditures in states offering waivers for PLWHA. They use fixed effects cross-sectional time series models to explore these state factors. States with Democratic governors were more likely to offer waiver services and were found to have higher rates of use and greater expenditures and to devote a larger share of long-term care dollars to waiver services for PLWHA. State supply of both institutional and residential care beds was negatively related to use and expenditures. Medicaid community-based care has been found to be related to improved outcomes and reduced costs o... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1435539 Mon, 12 May 2008 04:00:00 +0100 1435539 http://www.medworm.com/index.php?rid=1435538&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F3%2F315%3Frss%3D1 The authors develop a hybrid model of health care use that blends features of the traditional Aday—Andersen behavioral model with the socioecological modeling perspective. They use the model to conceptualize the various levels of influence expected from socioecological variables in individuals' mammography use decisions, build contextual variables from fine-grained data into four different types of geographic areas, and then use two- and three-level modeling of personal and area-level contextual factors to explain observed behavior. The central focus is on whether differentiating the conceptualized levels of influence seems to materially affect regression findings. The test could conceivably be confounded by the modifiable areal unit problem, but little evidence for this is found. Fi... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1435538 Mon, 12 May 2008 04:00:00 +0100 1435538 http://www.medworm.com/index.php?rid=1435537&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F3%2F300%3Frss%3D1 This article compares VA use and expenditures among primary care users at 76 VA-staffed community clinics (n = 17,060) and 32 non-VA contract community clinics receiving capitation (n = 6,842) using VA administrative databases. It estimates utilization using negative binomial models and expenditures using generalized linear one-part or two-part models. Contract community clinic patients are less likely to use all types of outpatient services than VA-staffed community clinic patients but had similar quality of care. For patients seeking care, contract community clinic patients had similar specialty care expenditures but lower primary care, outpatient, and overall expenditures. Results suggest that capitated contract clinics did not shift costs to specialty care and appeared to be an economi... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1435537 Mon, 12 May 2008 04:00:00 +0100 1435537 http://www.medworm.com/index.php?rid=1435536&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F3%2F259%3Frss%3D1 This article reviews the literature on the relationship between the structural characteristics and organizational processes of hospitals and quality of care. The review uses Donabedian's structure—process—outcome and level of analysis frameworks to organize the literature. The results of this review indicate that a preponderance of studies are conducted at the hospital level of analysis and are predominantly focused on the organizational structure—quality outcome relationship. The article concludes with recommendations of how health services researchers can expand their research to enhance one's understanding of the relationship between organizational characteristics and quality of care. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1435536 Mon, 12 May 2008 04:00:00 +0100 1435536 http://www.medworm.com/index.php?rid=1290542&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F2%2F232%3Frss%3D1 Data from a large sample of nursing homes are used to examine the association between use of nurse aide agency staff and quality. Agency use data come from a survey conducted in 2005 (N = 2,840), and the quality indicators come from the Nursing Home Compare Web site. The authors found a nonlinear relationship between nurse aide agency levels and quality; however, in general, higher nurse aide agency levels were associated with low quality. The results have policy and practice implications, the most significant of which is that use of nurse aide agency staff of less than 14 full-time equivalents per 100 beds has little influence on quality, whereas nurse aide agency staff of more than 25 full-time equivalents per 100 beds has a substantial influence on quality. (Source: Medical Care Researc... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1290542 Mon, 10 Mar 2008 04:00:00 +0100 1290542 http://www.medworm.com/index.php?rid=1290541&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F2%2F207%3Frss%3D1 This article assesses the role of market conditions and other factors in influencing hospital responses to LF activities at the community level. Community characteristics were found to be important in explaining hospital participation in a LF safety standards survey at the study sites. However, characteristics of the individual hospitals, and of the LF goals themselves, were more important in explaining the relatively limited progress by hospitals across all sites in achieving those goals over a 5-year period. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1290541 Mon, 10 Mar 2008 04:00:00 +0100 1290541 http://www.medworm.com/index.php?rid=1290540&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F2%2F187%3Frss%3D1 There is substantial interest in attempts to reduce the number of uninsured persons by providing subsidies to small businesses. To measure the responsiveness of small businesses to offers of subsidized coverage, the authors conducted a randomized controlled trial in which selected groups of San Diego businesses were offered the opportunity to purchase coverage at prices ranging from $20 to $100 per month for an employee-only policy. At $20 per month, an estimated 40% of eligible businesses purchased insurance; at $100 per month, 13% purchased insurance. Small businesses not currently offering insurance to employees are not very responsive to large reductions in the price of coverage. Programs to subsidize insurance for small businesses and their employees are unlikely to substantially redu... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1290540 Mon, 10 Mar 2008 04:00:00 +0100 1290540 http://www.medworm.com/index.php?rid=1290539&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F2%2F167%3Frss%3D1 In this study, the authors studied patients with coronary heart disease (CHD). The authors surveyed 225 medical practices in 2000 and 2001 and obtained information on quality measures from the medical records for more than 1,600 of their patients with CHD. Results suggest that quality of care, at least for common conditions with agreed-on measures, is not strongly influenced by financial characteristics of medical practices, although there does seem to be some relationship with practice structure such as size and quality. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1290539 Mon, 10 Mar 2008 04:00:00 +0100 1290539 http://www.medworm.com/index.php?rid=1290538&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F2%2F131%3Frss%3D1 Twenty stochastic frontier analysis (SFA) studies of hospital inefficiency in the United States were analyzed. Results from best-practice methods were compared against previously used methods in hospital studies to ascertain the robustness of SFA in estimating cost inefficiency. To compare past studies and analyze new data, SFA methods were varied by (a) the assumptions of the structure of costs and distribution of the error term, (b) inclusion of quality and product descriptor measures, and (c) use of simultaneous and two-stage estimation techniques. SFA results were relatively insensitive to several model variations. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1290538 Mon, 10 Mar 2008 04:00:00 +0100 1290538 http://www.medworm.com/index.php?rid=1138783&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F1%2F114%3Frss%3D1 This article uses a sample of Medicare beneficiaries from the 2003 Medical Expenditure Panel Survey to estimate how changes in actual drug use during a 1-year period affect estimated annual costs, given the initial choice of the lowest-cost PDP. While 57% of the sample had no difference in expenditure for plans selected based on initial versus end-of-the-year drug lists, 43% experienced average increases of $556 in annualized expenses due to drug switches. Implementable suggestions for improving the selection of Part D plans are provided. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1138783 Wed, 09 Jan 2008 05:00:00 +0100 1138783 http://www.medworm.com/index.php?rid=1138782&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F1%2F88%3Frss%3D1 This study uses data from the HIV Cost and Services Utilization Study to assess the effect of care team composition on the quality of HIV care. In adjusted analyses, care teams composed of three or more clinicians were associated with more consistent prescribing of pneumocystis carinii pneumonia prophylaxis when medically indicated ( p < .01). Patients with multiple physicians generally reported worse care coordination, however, and had more inappropriate use of emergency services. These findings indicate both advantages and disadvantages to having multiple clinicians. More effort should be devoted to facilitating coordination when multiple clinicians provide care. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1138782 Wed, 09 Jan 2008 05:00:00 +0100 1138782 http://www.medworm.com/index.php?rid=1138781&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F1%2F67%3Frss%3D1 This study contributes to the literature measuring outcomes of medical errors and provides evidence that AHRQ PSIs may be useful indicators for comparison across delivery systems. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1138781 Wed, 09 Jan 2008 05:00:00 +0100 1138781 http://www.medworm.com/index.php?rid=1138780&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F1%2F40%3Frss%3D1 This article reviews the evidence from 55 peer-reviewed articles on interventions that potentially reduce hospitalizations from formal long-term care settings. The interventions showing the strongest potential are those that increase skilled staffing, especially through physician assistants and nurse practitioners; improve the hospital-to-home transition; substitute home health care for selected hospital admissions; and align reimbursement policies such that providers do not have a financial incentive to hospitalize. Much of the evidence is weak and could benefit from improved research design and methodology. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1138780 Wed, 09 Jan 2008 05:00:00 +0100 1138780 http://www.medworm.com/index.php?rid=1138779&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F65%2F1%2F3%3Frss%3D1 This article critically reviews the association between the decision to hospitalize and factors related to the residents' welfare and preferences, the providers' attitudes, and the financial implications of hospitalization. Regarding the resident's welfare, factors associated with hospitalization included sociodemographics, health characteristics, nurse staffing, the presence of ancillary services, and the use of hospices. Patient preferences (e.g., advance directives) and provider attitudes (e.g., overburdening of staff) were also associated with increased hospitalization. Finally, financial variables related to hospitalization included nursing home ownership status and state Medicaid policies, such as nursing home payment rates and bed-hold requirements. Most studies relied on potentiall... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1138779 Wed, 09 Jan 2008 05:00:00 +0100 1138779 http://www.medworm.com/index.php?rid=1056461&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F6%2F731%3Frss%3D1 The 1990s featured pronounced policy change that had important effects on safety net providers and their ability to care for the uninsured. The authors examined how changes in public policy affected hospital uncompensated care (UC) between 1990 and 2000. They found that aggregate state Medicaid Disproportionate Share Hospital spending had no impact on UC provision. Expanding public health insurance eligibility for children and adults and increasing Medicaid managed care had small negative effects on UC provision. State and local tax appropriations had the largest impact on UC provision. A better understanding of the effect of health care policies on UC provision is essential in crafting new policies and better anticipating their impact. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056461 Wed, 28 Nov 2007 05:00:00 +0100 1056461 http://www.medworm.com/index.php?rid=1056460&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F6%2F706%3Frss%3D1 Although breast and cervical cancer screening rates for Asian American (AA) women are the lowest of any ethnic group in California, few causes for this are known. The authors used the 2001 California Health Interview Survey, conducted in five Asian languages, to conduct the first evaluation of Pap and mammography screening rates for a representative sample of 2,239 AA women. Wide variations in screening rates were found among the seven different subgroups of AA women studied: adjusted Pap test use ranged from 81% (Filipina Americans) to 61% (Vietnamese Americans). Mammography rates ranged from 78% (Japanese Americans) to 53% (Korean Americans). Disaggregating the AA data and using separate multivariate logistic regressions revealed that different factors were independently associated with ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056460 Wed, 28 Nov 2007 05:00:00 +0100 1056460 http://www.medworm.com/index.php?rid=1056459&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F6%2F691%3Frss%3D1 Little is known about the quality of care that veterans obtain in the private sector. To explore this issue, we identified the hospital in which 4,008 veterans enrolled in the Veterans Administration (VA) obtained coronary artery bypass graft (CABG) surgery in the New York private sector between 1997 and 2000. We used published risk-adjusted mortality rates to assign New York CABG centers to performance quintiles. VA patients with the lowest incomes were 2.4 times more likely than those in the highest incomes to use the highest-mortality hospitals (95 percent CI: 2.0—3.0). Compared with white patients, black (OR 1.8; 95 percent CI: 1.2—2.8) and Hispanic VA patients (OR 1.6; 95 percent CI: 0.9—2.8) were more likely to use the highest-mortality hospitals. About one third of... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056459 Wed, 28 Nov 2007 05:00:00 +0100 1056459 http://www.medworm.com/index.php?rid=1056458&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F6%2F673%3Frss%3D1 This study compared the characteristics of community nursing homes where veterans received their care with those of facilities that did not treat veterans from 1999 to 2002 using the Centers for Medicare and Medicaid Services (CMS) Online Survey Certification and Reporting system data merged with the CMS Minimum Data Set. A structure, process, and outcome model was used to examine whether the presence of per diem veterans had any impact on multidimensional quality measures. Facilities with any veterans were less likely to meet recommended nurse staffing standards; more likely to have patients with tube feeding, new catheterizations, and mobility restraints; and more likely to have actual harm citations and new pressure sores, plus quality-of-care, quality-of-life, and total deficiencies, t... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056458 Wed, 28 Nov 2007 05:00:00 +0100 1056458 http://www.medworm.com/index.php?rid=1056457&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F6%2F650%3Frss%3D1 This article provides a systematic review of the literature on physician acceptance of information technology. An overview of the technology acceptance model (TAM) is discussed, and a modified version of this model is proposed. Finally, ideas for testing this new model in a physician setting are presented. By providing a better understanding of physician technology acceptance, this model will inform health care managers about barriers that make physicians hesitant to embrace new technologies designed to increase efficiency and improve quality in a health care setting. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056457 Wed, 28 Nov 2007 05:00:00 +0100 1056457 http://www.medworm.com/index.php?rid=1056456&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F6%2F623%3Frss%3D1 The author conducted a structured literature review of instruments for evaluating shared medical decision making. She included relevant instruments that were generalizable beyond specific situations and had been formally evaluated and organized them by domains of values or preferences, information and communication in decision making, and other aspects of decision making. For values or preferences, the author identified 11 instruments, mostly on preferences for roles and information. For information and communication, she found a systematic review of instruments for observational assessment of decision making, 3 additional observational instruments, and 3 questionnaires. For other aspects of decision making, the author identified 3 instruments in domains such as decision self-efficacy and ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056456 Wed, 28 Nov 2007 05:00:00 +0100 1056456 http://www.medworm.com/index.php?rid=1056469&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5_suppl%2F283S%3Frss%3D1 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... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056469 Tue, 02 Oct 2007 04:00:00 +0100 1056469 http://www.medworm.com/index.php?rid=1056468&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5_suppl%2F243S%3Frss%3D1 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 intervent... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056468 Tue, 02 Oct 2007 04:00:00 +0100 1056468 http://www.medworm.com/index.php?rid=1056467&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5_suppl%2F195S%3Frss%3D1 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 manageme... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056467 Tue, 02 Oct 2007 04:00:00 +0100 1056467 http://www.medworm.com/index.php?rid=1056466&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5_suppl%2F157S%3Frss%3D1 There are significant disparities in treatment process and symptomatic and functional outcomes in depressive disorders for racial and ethnic minority patients. Using a life-course perspective, the authors conducted a systematic review of the literature to identify modifiable mechanisms and effective interventions for prevention and treatment at specific points—system, community, provider, and individual patient—in health care settings. Multicomponent chronic disease management interventions have produced improvements in depression outcomes for ethnic minority populations. Case management appears to be a key component of effective interventions. Socioculturally tailored treatment and prevention interventions may be more efficacious than standard treatment programs. Future resear... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056466 Tue, 02 Oct 2007 04:00:00 +0100 1056466 http://www.medworm.com/index.php?rid=1056465&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5_suppl%2F101S%3Frss%3D1 This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/e... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056465 Tue, 02 Oct 2007 04:00:00 +0100 1056465 http://www.medworm.com/index.php?rid=1056464&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5_suppl%2F29S%3Frss%3D1 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 ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056464 Tue, 02 Oct 2007 04:00:00 +0100 1056464 http://www.medworm.com/index.php?rid=1056463&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5_suppl%2F7S%3Frss%3D1 In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventi... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056463 Tue, 02 Oct 2007 04:00:00 +0100 1056463 http://www.medworm.com/index.php?rid=1056462&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F64%2F5_suppl%2F5S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=1056462 Tue, 02 Oct 2007 04:00:00 +0100 1056462 http://www.medworm.com/index.php?rid=884726&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5%2F600%3Frss%3D1 Consumer Assessment of Health Care Providers and Systems (CAHPS) is an organized effort to provide consumers with standardized, comprehensible, and usable data regarding consumers' experiences with health care. In its Medicare and other summary reports, CAHPS emphasizes the frequency of the most positive experiences. Cognitive models of survey response combined with attitude theory suggest that performance measurement might be further improved by the addition of problem-oriented reporting, which highlights the frequency of negative experiences. We propose criteria and use them to assess whether problem-oriented reporting provides valid, precise, and complementary information. Analysis of the 2000 CAHPS Medicare Fee-For-Service and 2001 CAHPS Medicare Advantage survey data shows that proble... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884726 Wed, 19 Sep 2007 04:00:00 +0100 884726 http://www.medworm.com/index.php?rid=884725&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5%2F585%3Frss%3D1 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. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884725 Wed, 19 Sep 2007 04:00:00 +0100 884725 http://www.medworm.com/index.php?rid=884724&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5%2F568%3Frss%3D1 This article examines how proximity to the nearest publicly funded test site affects HIV testing. Using a sample of 5,361 Los Angeles County adults, multinomial logit models estimated simultaneously the likelihood of (1) obtaining an HIV test in the prior 2 years, and (2) testing in a private physician's office, a publicly funded medical clinic, or in a nonmedical setting, such as a bar or bathhouse. Low-income Los Angeles residents rely on publicly funded sites for HIV testing. When public sites are more distant, poor individuals are less likely to use them and less likely to get tested. Distance from public sites does not affect HIV testing among the nonpoor. To encourage HIV testing among the groups where HIV is growing fastest, public health agencies must keep the time and money costs ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884724 Wed, 19 Sep 2007 04:00:00 +0100 884724 http://www.medworm.com/index.php?rid=884723&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5%2F544%3Frss%3D1 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 greate... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884723 Wed, 19 Sep 2007 04:00:00 +0100 884723 http://www.medworm.com/index.php?rid=884722&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5%2F518%3Frss%3D1 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. T... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884722 Wed, 19 Sep 2007 04:00:00 +0100 884722 http://www.medworm.com/index.php?rid=884721&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5%2F475%3Frss%3D1 The purpose of this article is to review the literature from 1980 to 2005 regarding organ donation decision making by African Americans for themselves and their loved ones and recommend improvements in subsequent studies. Using the behavioral model of health services utilization as an organizing framework, the review procedure consists of a (1) search of health and medical literature using several key words and eight indexes, (2) selection of articles based on specific criteria, and (3) review of each article with regard to the population and sample used, study design, dependent variables addressed, and its findings. The review indicates that predisposing, enabling, and need factors each influence African Americans' organ donation decision making. Retrospective chart reviews provide a good... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884721 Wed, 19 Sep 2007 04:00:00 +0100 884721 http://www.medworm.com/index.php?rid=884720&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5S%2F283S%3Frss%3D1 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... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884720 Wed, 19 Sep 2007 04:00:00 +0100 884720 http://www.medworm.com/index.php?rid=884719&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5S%2F243S%3Frss%3D1 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 intervent... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884719 Wed, 19 Sep 2007 04:00:00 +0100 884719 http://www.medworm.com/index.php?rid=884718&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5S%2F195S%3Frss%3D1 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 manageme... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884718 Wed, 19 Sep 2007 04:00:00 +0100 884718 http://www.medworm.com/index.php?rid=884717&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5S%2F157S%3Frss%3D1 There are significant disparities in treatment process and symptomatic and functional outcomes in depressive disorders for racial and ethnic minority patients. Using a life-course perspective, the authors conducted a systematic review of the literature to identify modifiable mechanisms and effective interventions for prevention and treatment at specific points—system, community, provider, and individual patient—in health care settings. Multicomponent chronic disease management interventions have produced improvements in depression outcomes for ethnic minority populations. Case management appears to be a key component of effective interventions. Socioculturally tailored treatment and prevention interventions may be more efficacious than standard treatment programs. Future resear... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884717 Wed, 19 Sep 2007 04:00:00 +0100 884717 http://www.medworm.com/index.php?rid=884716&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5S%2F101S%3Frss%3D1 This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/e... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884716 Wed, 19 Sep 2007 04:00:00 +0100 884716 http://www.medworm.com/index.php?rid=884715&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5S%2F29S%3Frss%3D1 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 ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884715 Wed, 19 Sep 2007 04:00:00 +0100 884715 http://www.medworm.com/index.php?rid=884714&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F5S%2F7S%3Frss%3D1 In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventi... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884714 Wed, 19 Sep 2007 04:00:00 +0100 884714 http://www.medworm.com/index.php?rid=884713&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F64%2F5S%2F5S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=884713 Wed, 19 Sep 2007 04:00:00 +0100 884713 http://www.medworm.com/index.php?rid=784802&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F4%2F449%3Frss%3D1 This work summarizes how hospital discharge data are used, identifies strengths and shortcomings, and presents suggestions for enhancing usefulness of the data. Results demonstrate that discharge data are used in a wide range of applications by diverse users. Uses include public health and population-based applications, as well as quality assessment, informed purchasing, strategic planning, and policymaking. Strategies to enhance the utility of discharge data include: improving the quality of existing data elements and adding new data elements that will support more advanced analyses, improving linkages with data from nonhospital settings and databases outside health care, and developing a technical assistance network to support statewide data organizations in their efforts to collect and ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=784802 Tue, 07 Aug 2007 04:00:00 +0100 784802 http://www.medworm.com/index.php?rid=784801&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F4%2F431%3Frss%3D1 The objective of this research was to examine whether users of mental health or substance abuse (MH/SA) services incurred greater costs for non-MH/SA services than nonusers of MH/SA services. Two years of health care utilization data were collected on 443 at-risk drinkers from six southern U.S. states. We then examined predictors of using MH/SA services and costs associated with non-MH/SA services. The results showed that use of MH/SA services was associated with female gender, military service, health insurance, and not being employed full-time. Unadjusted analyses indicated that non-MH/SA service costs were significantly higher among MH/SA service users than nonusers. However, this association did not endure in multivariable models. In fact, emergency department costs were significantly ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=784801 Tue, 07 Aug 2007 04:00:00 +0100 784801 http://www.medworm.com/index.php?rid=784800&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F4%2F416%3Frss%3D1 This study sought to understand if shared decision making and/or receipt of mental health care was associated with patient satisfaction for patients with depression and to determine whether gender modified this relationship. The data are from the Quality Improvement for Depression study, a national collaborative study of 1,481 patients diagnosed with major depression in managed care settings. The cross-sectional analyses were performed using multiple logistic regression on a sample of 1,317 patients who answered both the baseline and month six questionnaires. Shared decision making and receipt of mental health care were both positively associated with patient satisfaction. Gender was not a moderator of this relationship. Health plans may be able to improve patient satisfaction levels by te... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=784800 Tue, 07 Aug 2007 04:00:00 +0100 784800 http://www.medworm.com/index.php?rid=784799&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F4%2F395%3Frss%3D1 Physician ownership of specialty hospitals has become commonplace in recent years in several states where certificate-of-need laws do not exist. The study examines trends in utilization rates for complex and simple spinal fusion procedures performed on injured workers with back/spine disorders in two markets in Oklahoma. During the time period we examine, physician-owned spine or orthopedic specialty hospitals entered both market areas in Oklahoma. Because there were no market areas in Oklahoma without physician-owned spine or orthopedic hospitals to use as a comparison group, we also analyzed trends in utilization for these surgical procedures performed on Medicare beneficiaries. We compared utilization for these procedures in Oklahoma and three other states with a high concentration of p... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=784799 Tue, 07 Aug 2007 04:00:00 +0100 784799 http://www.medworm.com/index.php?rid=784798&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F4%2F379%3Frss%3D1 While consumers are increasingly expected to use complex health care information to make informed decisions, it is unclear how many have the skills to do so. In this investigation we examine health literacy, numeracy, and patient activation, assessing the contribution of each to the comprehension of comparative health care performance reports and their use in making an informed choice. A convenience sample of 303 employed-age adults participated in the study. The findings indicate that numeracy skill is the strongest predictor of comprehension, followed by health literacy. Higher activation helps those low in literacy and numeracy compensate for their lower skills and achieve higher levels of comprehension. In addition, making good choices, when trade-offs are necessary, is related to acti... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=784798 Tue, 07 Aug 2007 04:00:00 +0100 784798 http://www.medworm.com/index.php?rid=784797&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F4%2F351%3Frss%3D1 Despite documented preferences for home death, the majority of deaths from terminal illness occur in hospital. To better understand variation in place of death, we conducted a systematic literature review and a multilevel analysis in which we linked death certificates with county and state data. The results of both components revealed that opportunities for home death are disproportionately found in certain groups of Americans; more specifically, those who are White, have greater access to resources and social support, and die of cancer. From the multilevel analysis, the higher the proportion minority and the lower the level of educational attainment, the higher the probability of hospital death while investment in institutional long-term care, measured by regional density of nursing home ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=784797 Tue, 07 Aug 2007 04:00:00 +0100 784797 http://www.medworm.com/index.php?rid=618094&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F3%2F331%3Frss%3D1 This study reports results of a survey regarding attitudes toward P4Q among physicians participating in such programs in Massachusetts and California. Findings indicate physicians have generally positive attitudes toward the concept of P4Q, but are ambivalent about certain features of these programs as currently designed and implemented. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618094 Wed, 16 May 2007 04:00:00 +0100 618094 http://www.medworm.com/index.php?rid=618093&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F3%2F304%3Frss%3D1 This study found substantial expenditure persistence during a 3-year period. Among Temporary Aid to Needy Families (TANF) children in HMOs in the top 10 percent of the expenditure distribution in 2003, 34 percent remained in the top 10 percent in 2004, and 23 percent remained in the top 10 percent in 2005. Similar patterns were observed for TANF children in the PCCM. Expenditure persistence varied based on the enrollees' enabling and need characteristics, providing opportunities to identify children with high health care expenditures who may benefit from care coordination. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618093 Wed, 16 May 2007 04:00:00 +0100 618093 http://www.medworm.com/index.php?rid=618092&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F3%2F279%3Frss%3D1 Many innovations in the health sector are complex, requiring coordinated use by multiple organizational members to achieve benefits. Often, complex innovations are adopted with great anticipation only to fail during implementation. The health services literature provides limited conceptual guidance to researchers and practitioners about implementation of complex innovations. In the present study, we adapt an organizational framework of innovation implementation developed and validated in a manufacturing setting and explore the extent to which it aptly characterizes implementation in health sector organizations. Through comparative case studies of four cancer clinical research networks, we illustrate how this conceptual framework captures key determinants of the implementation of new progra... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618092 Wed, 16 May 2007 04:00:00 +0100 618092 http://www.medworm.com/index.php?rid=618091&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F3%2F235%3Frss%3D1 Innovations in health care account for some of the most dramatic improvements in population health outcomes in the developed world as well as for a nontrivial proportion of growth in expenditures. Provider organizations are the adopters of many of these innovations, and understanding the factors that inhibit or facilitate their diffusion to and possible disengagement from these organizations is important in addressing cost, quality, and access issues. Given the importance of these issues, the purpose of this article is to (1) create a comprehensive census of studies examining the adoption of and disengagement from innovations in health care provider organizations; (2) organize these studies into an inductively derived classification scheme; (3) assess the studies' strengths and weaknesses;... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618091 Wed, 16 May 2007 04:00:00 +0100 618091 http://www.medworm.com/index.php?rid=618102&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2_suppl%2F144S%3Frss%3D1 A robust set of quality measures is essential to provide consumers with a vehicleto evaluate nurses' contributions to the care of hospitalized patients, providers, and systems with a set of nursing processes and outcomes to guide quality improvement, and insurers with indicators to reward hospitals for high quality nursing services. The processes employed by the Nursing Care Performance Measures Steering Committee convened by the National Quality Forum (NQF) in 2004 resulted in the endorsement of 15 indicators of health care quality influenced by nurses and contributed to the identification of significant gaps in measurement and priority areas for future research. This critical review of the state of the science related to health care processes and outcomes that reflect nurses' contributio... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618102 Fri, 20 Apr 2007 04:00:00 +0100 618102 http://www.medworm.com/index.php?rid=618101&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2_suppl%2F123S%3Frss%3D1 The purpose of this article is to present findings from a review of published systematic/integrative reviews and meta-analyses on nursing interventions and patient outcomes in acute care settings. A literature search was conducted for the period 1999-2005, producing 4,000 systematic/integrative reviews and 500 meta-analyses covering seven topics selected by the authors: elder care, caregivers, developmental care of neonates and infants, symptom management, pressure ulcer prevention/treatment, incontinence, and staffing. The association between nursing care interventions/processes and patient outcomes in acute care settings was found to be limited in the articles reviewed. The strongest evidence was for the use of patient risk-assessment tools and interventions implemented by nurses to prev... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618101 Fri, 20 Apr 2007 04:00:00 +0100 618101 http://www.medworm.com/index.php?rid=618100&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2_suppl%2F104S%3Frss%3D1 This article evaluates the utility of published multidimensional instruments to measure the nursing practice environment. The assessment criteria are theoretical relevance, ease of use, and dissemination. This article also synthesizes the research that has used these instruments. Seven instruments and 54 studies are evaluated. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is proposed as the most useful instrument. Its content, length, and dissemination best satisfy the set of criteria. Researchers should use the PES-NWI to generate consistent and comparable evidence; expand the content to reflect all conceptual domains; develop a short form; test the instrument in different care settings; expand the evidence of the practice environment's influence on patient outcomes; ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618100 Fri, 20 Apr 2007 04:00:00 +0100 618100 http://www.medworm.com/index.php?rid=618099&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2_suppl%2F82S%3Frss%3D1 This article will highlight a number of key issues learned from the field and suggest opportunities for research into the design and deployment of these measures. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618099 Fri, 20 Apr 2007 04:00:00 +0100 618099 http://www.medworm.com/index.php?rid=618098&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2_suppl%2F64S%3Frss%3D1 This article explicates a comprehensive process for identifying, specifying, testing, and implementing nationally standardized performance measures. A growing body of research ties nurse staffing to patient outcomes, reinforcing the important role of nursing in the delivery of safe, efficacious health care. The Joint Commission has developed a multistep process to identify robust sets of evidence-based measures that includes a review of the evidence, expert advisory panel guidance, use of established criteria, public input and comment, and multistage field testing before implementation. This proven approach to the establishment of performance metrics is applicable to the identification and implementation of nurse-sensitive workforce measures. These metrics can then be used by providers to ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618098 Fri, 20 Apr 2007 04:00:00 +0100 618098 http://www.medworm.com/index.php?rid=618097&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2_suppl%2F44S%3Frss%3D1 This article summarizes existing data sources and recommendations for improving measures, data collection, and research on nurse-sensitive care. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618097 Fri, 20 Apr 2007 04:00:00 +0100 618097 http://www.medworm.com/index.php?rid=618096&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2_suppl%2F10S%3Frss%3D1 This article reviews recent efforts and issues involved in identifying a set of nursing-sensitive performance measures. Sustaining and strengthening current efforts requires developing measures that address all the domains of nursing, addressing technical issues needed to analyze the impact of nursing on patient safety and health care outcomes, developing data systems that provide the information needed to implement the model system, regularly improving the set of endorsed standards to reflect the most current science and empirical evidence, and persuading all health care stakeholders that measurement and reporting nursing-sensitive standards make a difference in the care and quality that are delivered. Each of these tasks requires substantial development work and construction and maintena... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618096 Fri, 20 Apr 2007 04:00:00 +0100 618096 http://www.medworm.com/index.php?rid=618095&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F64%2F2_suppl%2F3S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=618095 Fri, 20 Apr 2007 04:00:00 +0100 618095 http://www.medworm.com/index.php?rid=520243&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2%2F212%3Frss%3D1 This article provides the first national estimates of actuarial values and out-of-pocket spending from the era of nonrestrictive managed care that began in the late 1990s. Employer plans paid about 84 percent of total medical expense for those with employer-sponsored coverage in 2004, about 1 percent less than in 2000, and high users faced potential out of pocket spending in the thousands of dollars when they received a portion of their care out of network. Since 2004, more employers have offered plans with higher deductibles coupled with employer-funded personal accounts. These arrangements can result in low out of pocket costs for many employees, but high users will face substantially higher costs. Many employers adopting high-deductible plans are not contributing to personal accounts. T... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=520243 Tue, 03 Apr 2007 04:00:00 +0100 520243 http://www.medworm.com/index.php?rid=520242&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2%2F191%3Frss%3D1 We know little about factors associated with job satisfaction and dissatisfaction for nursing home workers. In this investigation, the authors use data from a large sample of nursing home administrators (NHAs) to examine: (1) their levels of job satisfaction, (2) whether job satisfaction is associated with intent to leave, (3) whether job satisfaction is associated with turnover after 1 year, and (4) whether job satisfaction after 1 year varies for NHAs who left based on where they subsequently worked. Overall, NHAs were more satisfied with the job satisfaction subscales of: rewards, work skills, and workload but were less satisfied with work demands and coworkers. NHAs appeared particularly sensitive to work skills, with this area of job satisfaction being associated with intent to turnov... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=520242 Tue, 03 Apr 2007 04:00:00 +0100 520242 http://www.medworm.com/index.php?rid=520241&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2%2F169%3Frss%3D1 Much effort has been put into improving measures of health care quality. Although early research suggested that consumers made little use of quality reports, most reports were based on nonstandardized measures and were not user friendly. Information presentation approaches, however, will have a significant influence on what information is attended and used. The present research examines whether information presentation methods differentially influence consumers who differ in numeric skills. Results of three studies support the idea that "less is more" when presenting consumers with comparative performance information to make hospital choices. Results were particularly strong for those lower in numeracy, who had higher comprehension and made better choices when the information-presentation ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=520241 Tue, 03 Apr 2007 04:00:00 +0100 520241 http://www.medworm.com/index.php?rid=520240&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2%2F148%3Frss%3D1 Financial pressure mounted for hospitals nationwide during the late 1990s. Our study examines how this affected the quality of their operations in terms of organizational infrastructure and processes that support the delivery of care. Our sample consisted of community hospitals operating between 1995 and 2000. Financial pressure was measured based on changes in net patient revenues per adjusted patient day and the ratio of cash flow to total revenues. The authors examined effects on hospital investments in plant and equipment and on hospital standards compliance with selected Joint Commission on Accreditation of Healthcare Organization performance areas. The results suggest that increasing financial pressures did lead to cutbacks in these areas. These findings suggest the importance of loo... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=520240 Tue, 03 Apr 2007 04:00:00 +0100 520240 http://www.medworm.com/index.php?rid=520239&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2%2F123%3Frss%3D1 New information and communication technology (ICT) has the potential to improve care for chronic conditions, deliver better health outcomes, and reduce direct and indirect costs. However, realizing these gains necessitates new forms of care delivery, through adoption of ICT, the specific choice of ICT, and changes to existing forms of health care delivery. Realizing these new forms of delivery requires appropriate payment policies. The authors review the literatures on health care payment and ICT in chronic care and then apply theoretical economic analysis to determine how ICT alters health care payment policy recommendations. Using diabetes as an example, the authors identify and illustrate the disease and technology features that determine the optimal form of payment. Overall, ICT shifts... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=520239 Tue, 03 Apr 2007 04:00:00 +0100 520239 http://www.medworm.com/index.php?rid=520238&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2S%2F144S%3Frss%3D1 A robust set of quality measures is essential to provide consumers with a vehicleto evaluate nurses' contributions to the care of hospitalized patients, providers, and systems with a set of nursing processes and outcomes to guide quality improvement, and insurers with indicators to reward hospitals for high quality nursing services. The processes employed by the Nursing Care Performance Measures Steering Committee convened by the National Quality Forum (NQF) in 2004 resulted in the endorsement of 15 indicators of health care quality influenced by nurses and contributed to the identification of significant gaps in measurement and priority areas for future research. This critical review of the state of the science related to health care processes and outcomes that reflect nurses' contributio... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=520238 Tue, 03 Apr 2007 04:00:00 +0100 520238 http://www.medworm.com/index.php?rid=520237&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F64%2F2S%2F123S%3Frss%3D1 The purpose of this article is to present findings from a review of published systematic/integrative reviews and meta-analyses on nursing interventions and patient outcomes in acute care settings. A literature search was conducted for the period 1999-2005, producing 4,000 systematic/integrative reviews and 500 meta-analyses covering seven topics selected by the authors: elder care, caregivers, developmental care of neonates and infants, symptom management, pressure ulcer prevention/treatment, incontinence, and staffing. The association between nursing care interventions/processes and patient outcomes in acute care settings was found to be limited in the articles reviewed. The strongest evidence was for the use of patient risk-assessment tools and interventions implemented by nurses to prev... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=520237 Tue, 03 Apr 2007 04:00:00 +0100 520237