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. Wed, 18 Jan 2012 11:15:02 +0100 http://www.medworm.com/index.php?rid=5436256&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F6%2F725%3Frss%3D1 When comparing health care providers, patient experience data are usually adjusted for case-mix associations to ensure fair comparisons. Previous studies in the United States showed that case-mix associations sometimes vary across health care providers. Such variation could indicate differential provider behavior for patient subgroups, in which case current adjustment techniques might be inappropriate. To see whether this variation is also apparent in a health care system different from the U.S. system, the authors analyzed Dutch patients’ experiences with family practice care. Using multilevel random slope models, the associations between age, general health status, mental health status, education, sex, and ethnicity on one hand and reported experiences on the other hand were assess... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5436256 Mon, 21 Nov 2011 05:00:00 +0100 5436256 http://www.medworm.com/index.php?rid=5436255&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F6%2F712%3Frss%3D1 This study analyzes administrative impediments to enrollment in HEALTHpact, a high-deductible plan with premiums capped at 10% of the average Rhode Island wage. HEALTHpact includes an opportunity for enrollees to reduce their deductibles from $5,000 ($10,000 for a family) to $750 ($1,500 for a family) if they engage in prespecified wellness behaviors. A stakeholder panel was convened to develop guidelines for insurers, which, in turn, were required to develop products satisfying those guidelines. Implementation was examined using stakeholder interviews and archival documents. Results indicate that since no funds were allocated for education and monitoring, there was little opportunity to promote "bottom up" demand or to oversee insurers. They also indicate that both insurers and brokers ad... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5436255 Mon, 21 Nov 2011 05:00:00 +0100 5436255 http://www.medworm.com/index.php?rid=5436254&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F6%2F699%3Frss%3D1 Efforts to characterize geographic variation in health care utilization and spending have focused on patterns observed with Medicare data. The authors analyzed the Healthcare Cost and Utilization Project national all-payer data for inpatient stays to assess variation in hospitalizations by age groups and, consequently, to understand how utilization of the Medicare population may differ from the population of other payers. The authors found that the correlation between inpatient discharges and costs per capita for the Medicare-eligible population over 65 and younger age groups increased from moderate to strong with age. These findings suggest examining Medicare inpatient data alone may provide a useful but not comprehensive understanding how hospital utilization and costs vary for the total... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5436254 Mon, 21 Nov 2011 05:00:00 +0100 5436254 http://www.medworm.com/index.php?rid=5436253&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F6%2F683%3Frss%3D1 This study determines asthma-related health care access and utilization patterns for Latino children of Puerto Rican and Dominican origin residing in Rhode Island (RI) and Latino children residing in Puerto Rico (Island). Data included 804 families of children with persistent asthma recruited from clinics. Island children were less likely to receive regular asthma care and care from a consistent provider and more likely to have been to the emergency department and hospitalized for asthma than RI children. Island children were 2.33 times more likely to have used the emergency department for asthma compared with RI non-Latino White (NLW) children. Latino children residing in both Island and RI were less likely to have used specialty care and more likely to have had a physician visit for asth... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5436253 Mon, 21 Nov 2011 05:00:00 +0100 5436253 http://www.medworm.com/index.php?rid=5436252&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F6%2F667%3Frss%3D1 In 2008, Medicare implemented a policy limiting reimbursement to hospitals for treating avoidable hospital-acquired conditions (HACs). Although the policy will expand nationally to Medicaid programs in 2011, little is known about the impact on safety net hospitals. The authors conducted interviews with 60 chief quality officers and 55 chief financial officers from safety net hospitals to explore the impact of Medicare’s HACs policy during its first year. Despite the predicted small financial impact, the authors found that the policy gained the attention of hospital leaders and many governing boards. Although the policy reportedly provided additional motivation to reduce HACs, few hospitals implemented new care practices and instead focused on documenting conditions that are present f... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5436252 Mon, 21 Nov 2011 05:00:00 +0100 5436252 http://www.medworm.com/index.php?rid=5436251&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F6%2F650%3Frss%3D1 This article explores differences between internists and family practitioners in their suggested diagnoses, level of diagnostic certainty, test and prescription ordering, when encountering exactly the same "patient" with coronary heart disease (CHD). Internists were more certain of a CHD diagnosis than family practitioners and were more likely to act on this diagnosis. Family practitioners were more likely to diagnose (and were more certain of) a mental health condition. While many physicians simultaneously entertain several alternate diagnoses, diagnostic certainty has shown to have an important influence on subsequent clinical actions, such as stress testing and prescription of beta blockers. These results may inform future educational strategies designed to reduce diagnostic uncertainty... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5436251 Mon, 21 Nov 2011 05:00:00 +0100 5436251 http://www.medworm.com/index.php?rid=5436250&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F6%2F627%3Frss%3D1 Analysis of observational cohort data is subject to bias from unobservable risk selection. The authors compared econometric models and treatment effectiveness estimates using the linked Surveillance, Epidemiology, and End Results (SEER)–Medicare claims data for women diagnosed with ductal carcinoma in situ. Treatment effectiveness estimates for mastectomy and breast-conserving surgery (BCS) with or without radiotherapy were compared using three different models: simultaneous-equations model, discrete-time survival model with unobserved heterogeneity (frailty), and proportional hazards model. Overall trends in disease-free survival (DFS), or time to first subsequent breast event, by treatment are similar regardless of the model, with mastectomy yielding the highest DFS over 8 years of... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5436250 Mon, 21 Nov 2011 05:00:00 +0100 5436250 http://www.medworm.com/index.php?rid=5202313&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F5%2F607%3Frss%3D1 Many of the provisions in the Affordable Care Act (ACA), such as tax credits and penalties for employers, vary by employer size and average wage level. Therefore, knowing the wage and firm size distribution of low-wage workers and how employer-sponsored insurance (ESI) characteristics vary by these dimensions is particularly important for understanding the extent to which low-wage workers and their employers may be affected by different provisions in the ACA. To inform this issue, the authors use data from the 2006 Medical Expenditure Panel Survey—Insurance Component to examine offers of coverage and cost-sharing requirements by the wage distribution and firm size dimensions of employers. They also draw on Medical Expenditure Panel Survey household-level data to describe the househol... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5202313 Wed, 07 Sep 2011 04:00:00 +0100 5202313 http://www.medworm.com/index.php?rid=5202312&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F5%2F594%3Frss%3D1 Based on analyses of individual market health plans sold through ehealthinsurance and enrollment information collected from individual market carriers, this article profiles the individual health insurance market in 2007, before health reform. The article examines premiums, plan enrollment, cost sharing, and covered benefits and compares individual and group markets. Premiums for the young are lower than in the group market but higher for older people. Cost sharing is substantial in the individual insurance market. Seventy-eight percent of people were enrolled in plans with deductibles for single coverage, which averaged $2,117. Annual out-of-pocket maximums averaged $5,271. Many plans do not cover important benefits. Twelve percent of individually insured persons had no coverage for offic... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5202312 Wed, 07 Sep 2011 04:00:00 +0100 5202312 http://www.medworm.com/index.php?rid=5202311&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F5%2F579%3Frss%3D1 This study provides encouraging evidence to states about using consumer financial incentives for increasing preventive care use. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5202311 Wed, 07 Sep 2011 04:00:00 +0100 5202311 http://www.medworm.com/index.php?rid=5202310&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F5%2F559%3Frss%3D1 The objective of this study was to examine the reasons for different hospitalization rates between Medicaid and private-pay nursing home residents—to disentangle within-facility differences from across-facility variations in hospitalizations between these two types of residents. Multiple data sources (2003) for New York State were linked. Hospitalization was the dependent variable. Individual payer status was the main independent variable. Facilities were stratified into four groups by ownership status and bed-hold payment eligibility. We found both within-facility (Medicaid residents were more likely to be hospitalized than private-pay residents within a facility) and across-facility differences (facilities with a higher concentration of Medicaid residents were more likely to hospit... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5202310 Wed, 07 Sep 2011 04:00:00 +0100 5202310 http://www.medworm.com/index.php?rid=5202309&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F5%2F537%3Frss%3D1 Despite the appeal of peritoneal dialysis (PD) among patients, payers, and providers, its use in the United States has been limited and declining. Prior research has found that patient factors explain little variation in PD utilization, and little is known about the contribution of dialysis facility factors. The authors examined market factors associated with the provision of PD services in dialysis facilities between 1995 and 2003. Less than half of dialysis facilities offered PD. PD provision was not explained by disease trends or patient characteristics commonly associated with PD use. Facilities were more likely to offer PD in less competitive and less spatially concentrated markets. PD services may not be available to all patients who would benefit from it and there may be insufficien... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5202309 Wed, 07 Sep 2011 04:00:00 +0100 5202309 http://www.medworm.com/index.php?rid=5202308&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F5%2F523%3Frss%3D1 This article uses the Survey of Income and Program Participation to examine how the stability of children’s health insurance changed between 1990 and 2005 and to identify dynamic aspects of family life associated with transitions in coverage. Children’s health insurance instability has increased since the early 1990s, due to greater movement between insured and uninsured states and between private and public insurance coverage. Changes in the employment and marital status of the family head are highly associated with an increased risk of a child losing and gaining public and private coverage, largely in hypothesized directions. The exception is that marital dissolution and job loss are associated with an increased probability of a child losing public insurance, despite there be... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5202308 Wed, 07 Sep 2011 04:00:00 +0100 5202308 http://www.medworm.com/index.php?rid=5092974&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F4%2F504%3Frss%3D1 This study examines general attitudes toward CPGs to establish profiles according to these attitudes and to determine if these profiles are associated with awareness and with use of CPGs in daily practice. The authors conducted a cross-sectional telephone survey of 1,759 French GPs and measured (a) their general attitudes toward CPGs and (b) their awareness and use in daily practice of CPGs for six specific health problems. A bivariate probit model was used with sample selection to analyze the links between GPs’ general attitudes and CPG awareness/use. The authors found three GP profiles according to their opinions toward CPGs and a positive association between these profiles and CPG awareness but not use. It is important to build awareness of CPGs before GPs develop negative attitud... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5092974 Tue, 02 Aug 2011 23:00:00 +0100 5092974 http://www.medworm.com/index.php?rid=5092973&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F4%2F490%3Frss%3D1 This article estimates excess costs associated with postoperative complications among inpatients treated in Veterans Health Administration (VA) hospitals. The authors conducted an observational study on 43,822 hospitalizations involving inpatient surgery in one of 104 VA hospitals during fiscal year 2007. Hospitalization-level cost regression analyses were performed to estimate the excess cost of each of 18 unique postoperative complications. The authors used generalized linear modeling techniques to account for the heavily skewed cost distribution. Costs were measured using an activity-based cost accounting system and complications were assessed based on medical chart review conducted by the VA ‘National Surgical Quality Improvement Program. The authors found excess costs associated... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5092973 Tue, 02 Aug 2011 23:00:00 +0100 5092973 http://www.medworm.com/index.php?rid=5092972&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F4%2F462%3Frss%3D1 This study examined the association of depression screening with the diagnoses of mood disorders and prescription of antidepressants in 73,712 visits to nonpsychiatrist physician offices drawn from the 2005-2007 U.S. National Ambulatory Medical Care Survey. Physicians used depression screening selectively for patients whom they perceived as more likely to have a mood disorder. In bivariate probit analyses with instrumental variables, depression screening did not increase the prevalence of either mood disorder diagnoses or prescription of antidepressants. However, screening was associated with lower rates of antidepressants prescription without a diagnosis of a mood disorder. In visits in which antidepressants were prescribed, 47.4% of the screened visits compared with 16.3% of nonscreened ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5092972 Tue, 02 Aug 2011 23:00:00 +0100 5092972 http://www.medworm.com/index.php?rid=5092971&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F4%2F441%3Frss%3D1 This descriptive study assesses the access to care provided by five model and diverse safety net programs that enroll uninsured adults in a coordinated system offering primary care, hospital care, prescription drugs, and most specialist services. Physician use by safety net program members was similar to insured groups. However, there was less use of hospitals in the two programs that relied on uncompensated charity care. Considering access measures commonly used in population-based surveys, the uninsured in these five communities fared no better than uninsured elsewhere. However, respondents may consider enrollment in a well-structured safety net program to be equivalent to insurance. If so, population surveys may be least accurate in identifying uninsured people in the very communities t... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5092971 Tue, 02 Aug 2011 23:00:00 +0100 5092971 http://www.medworm.com/index.php?rid=5092970&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F4%2F421%3Frss%3D1 Trust in the source of information about physician quality is likely to be an important factor in how consumers use that information in encounters with their doctor or in decisions about choice of provider. In this article, the authors use survey data from a nationally representative sample of 8,140 individuals with chronic illness to examine variation in consumer trust in different sources of physician quality information and how market segmentation factors explain such variation. The authors find that consumers place greater trust in physicians and hospitals relative to institutional sources and personal sources. The level of trust, however, varies considerably across consumers as a function of demographic, socioeconomic, behavioral/lifestyle factors but is not related to measures of con... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5092970 Tue, 02 Aug 2011 23:00:00 +0100 5092970 http://www.medworm.com/index.php?rid=5092969&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F4%2F387%3Frss%3D1 This systematic literature review identified and summarized 35 studies that investigated the relationship between multiple chronic conditions (MCCs) and health care utilization outcomes (i.e. physician use, hospital use, medication use) and health care cost outcomes (medication costs, out-of-pocket costs, total health care costs) for elderly general populations. Although synthesis of studies was complicated because of ambiguous definitions and measurements of MCCs, and because of the multitude of outcomes investigated, almost all studies observed a positive association of MCCs and use/costs, many of which found that use/costs significantly increased with each additional condition. Several studies indicate a curvilinear, near exponential relationship between MCCs and costs. The rising preva... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=5092969 Tue, 02 Aug 2011 23:00:00 +0100 5092969 http://www.medworm.com/index.php?rid=4787180&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F3%2F367%3Frss%3D1 Collection of race, ethnicity, and primary language data of health plan members is a recognized important step in addressing disparities in health care. The authors conducted six focus groups to examine perceptions of Massachusetts consumers about collection and use of race/ethnicity and language data by health plans, preferences for how and when the data should be collected, and preferences for racial/ethnic categories. Consumers understood the utility of collecting primary language data from members but expressed concerns about the collection of race/ethnicity data. Despite these concerns, they provided suggestions for using the data to improve care. Their preferences for racial/ethnic categories suggested that they wanted a balance between simplicity and reasonable granular detail. Ulti... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4787180 Tue, 03 May 2011 23:00:00 +0100 4787180 http://www.medworm.com/index.php?rid=4787179&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F3%2F352%3Frss%3D1 This study examines whether affordability thresholds for medical care as defined by families change over time. The results from two nationally representative surveys show that while financial stress from medical bills—defined as the percent with problems paying medical bills—increased between 2003 and 2007, greater out-of-pocket spending accounted for this increase only for higher-income persons with employer-sponsored insurance coverage. Increased spending did not account for an increase in medical bill problems among lower-income persons. Moreover, the increase in medical bill problems among low-income persons occurred at relatively low levels of out-of-pocket spending rather than at higher levels. The results suggest that "affordability thresholds" for medical care as define... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4787179 Tue, 03 May 2011 23:00:00 +0100 4787179 http://www.medworm.com/index.php?rid=4787178&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F3%2F332%3Frss%3D1 This study assesses whether California’s minimum nurse staffing legislation affected the amount of uncompensated care provided by California hospitals. Using data from California’s Office of Statewide Health Planning and Development, the American Hospital Association Annual Survey and InterStudy, the authors divide hospitals into quartiles based on preregulation staffing levels. Controlling for other factors, they estimate changes in the growth rate of uncompensated care in the three lowest staffing quartiles relative to the quartile of hospitals with the highest staffing level. The sample includes short-term general hospitals over the period 1999 to 2006. The authors find that growth rates in uncompensated care are lower in the first three staffing quartiles as compared with t... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4787178 Tue, 03 May 2011 23:00:00 +0100 4787178 http://www.medworm.com/index.php?rid=4787176&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F3%2F311%3Frss%3D1 This study estimated the association of EMR implementation with nurse staffing levels, skill mix, contract/agency percent, and nurse-sensitive patient outcomes in U.S. hospitals. Data on nurse staffing and patient outcomes came from the 2004-2008 National Database of Nursing Quality Indicators. Data on EMR implementation came from the 2004-2008 HIMSS Analytics Database. The authors conducted a longitudinal analysis of an unbalanced panel of 3,048 medical/surgical units in 509 short-term, general acute care hospitals. EMR implementation was associated with lower total nurse hours per patient day, higher Registered Nurse percent and contract/agency percent, and higher adverse patient events in the short term. EMR may create a skill bias toward higher-skilled nurses. As more advanced EMR syst... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4787176 Tue, 03 May 2011 23:00:00 +0100 4787176 http://www.medworm.com/index.php?rid=4787175&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F3%2F290%3Frss%3D1 The objective was to analyze how well 1,006 hospitals performed across a broader range of measures. Five measures were developed from publicly available data: adherence to processes of care, 30-day readmission rates, in-hospital mortality, efficiency, and patient satisfaction. For a subset of hospitals, the authors included two survey-based assessments of patient care quality, one by chief quality officers and one by frontline clinicians. In general, there was little correlation among the publicly available measures (r ≤ .10), though there was notable correlation between objective measures and survey-based measures (r = .23). Hospitals that performed well on a composite measure calculated from the publicly available measures were often not in the top quintile on most individual measures... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4787175 Tue, 03 May 2011 23:00:00 +0100 4787175 http://www.medworm.com/index.php?rid=4787174&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F3%2F263%3Frss%3D1 The authors conducted a systematic literature review to assess whether quality indicators for diabetes care are related to patient outcomes. Twenty-four studies were included that formally tested this relationship. Quality indicators focusing on structure or processes of care were included. Descriptive analyses were conducted on the associations found, differentiating for study quality and level of analysis. Structure indicators were mostly tested in studies with weak designs, showing no associations with surrogate outcomes or mixed results. Process indicators focusing on intensification of drug treatment were significantly associated with better surrogate outcomes in three high-quality studies. Process indicators measuring numbers of tests or visits conducted showed mostly negative result... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4787174 Tue, 03 May 2011 23:00:00 +0100 4787174 http://www.medworm.com/index.php?rid=4620678&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F2%2F247%3Frss%3D1 The growth of ambulatory surgery centers (ASCs) as a setting for care in the United States raises unique safety concerns. In contrast to hospital-based outpatient departments (HOPDs), ASCs offer care at varying distances from hospital services potentially required to treat complications. To describe changes over time in the accessibility of hospital services for procedural outpatients, this study examined 4.3 million discharges for seven outpatient procedures frequently performed at ASCs and HOPDs. Between 2005 and 2007, the mean patient-to-emergency department (ED) distance increased by 12.4%. This change, which resulted from both an increase in the share of procedures performed at ASCs and an increase in the distance between ASCs and EDs, occurred predominantly within procedures that car... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620678 Mon, 21 Mar 2011 00:00:00 +0100 4620678 http://www.medworm.com/index.php?rid=4620677&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F2%2F226%3Frss%3D1 Previous studies documented racial and gender disparities in implantable cardioverter-defibrillator (ICD) placement. The authors examined whether racial and gender disparities in ICD placement are due to underutilization or overutilization. Among 1,054 adults hospitalized from 2001 to 2004 with ventricular arrhythmias in a large academic hospital, the study found that 17% of patients had clinical indicators concordant with ICD placement criteria. Among those, Blacks were less likely than Whites to receive an ICD (adjusted odds ratio [OR] = 0.24; 95% CI = 0.08-0.71). Among the 83% who were discordant with ICD placement criteria, Blacks (adjusted OR = 0.30; 95% CI = 0.18-0.52) and Hispanics (adjusted OR = 0.24, 95% CI = 0.10-0.57) were less likely than Whites, and women less likely than men,... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620677 Mon, 21 Mar 2011 00:00:00 +0100 4620677 http://www.medworm.com/index.php?rid=4620676&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F2%2F202%3Frss%3D1 The purpose of this study was to examine potential associations among ambulatory surgery centers’ (ASCs) organizational strategy, structure, and quality performance. The authors obtained several large-scale, all-payer claims data sets for the 1997 to 2004 period. The authors operationalized quality performance as unplanned hospitalizations at 30 days after outpatient arthroscopy and colonoscopy procedures. The authors draw on related organizational theory, behavior, and health services research literatures to develop their conceptual framework and hypotheses and fitted fixed and random effects Poisson regression models with the count of unplanned hospitalizations. Consistent with the key hypotheses formulated, the findings suggest that higher levels of specialization and the volume o... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620676 Mon, 21 Mar 2011 00:00:00 +0100 4620676 http://www.medworm.com/index.php?rid=4620675&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F2%2F177%3Frss%3D1 In service industries other than health care, unit employees who report a favorable service climate—characterized by commitment to a team concept and intrateam interactions that are supportive, collegial, and collaborative—have high levels of consumer satisfaction and work unit productivity. The authors evaluated whether similar primary care team (PCT) functioning influenced the short-term future health (SF-36) of elderly Medicare beneficiaries (N = 991) in a group model managed care organization (MCO). PCT functioning was assessed by surveys of practitioners and support staff on the MCO’s 14 primary care practices and included measures of perceived task delegation, role collaboration, patient orientation, and team ownership. On average, patient physical and emotional hea... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620675 Mon, 21 Mar 2011 00:00:00 +0100 4620675 http://www.medworm.com/index.php?rid=4620674&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F2%2F156%3Frss%3D1 This article incorporates synonyms and a uniform definition of terminology related to study designs, elements of an equation, and types of bias. Greater multidisciplinary collaboration and exploration of new methods can be facilitated by this methods thesaurus. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620674 Mon, 21 Mar 2011 00:00:00 +0100 4620674 http://www.medworm.com/index.php?rid=4620673&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F2%2F131%3Frss%3D1 This article reviews the literature on ED use by older adults within the context of evaluating their need for emergency care and the extent to which access to primary and supportive care services affect use. While a substantial research literature describes general patterns of ED use, there is much less research on ED use as a function of other health service use. Gaps in the research literature result in a limited understanding of the full scope of the issue and opportunities for practice and policy intervention. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620673 Mon, 21 Mar 2011 00:00:00 +0100 4620673 http://www.medworm.com/index.php?rid=4620684&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F68%2F1_suppl%2F101S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620684 Thu, 20 Jan 2011 00:00:00 +0100 4620684 http://www.medworm.com/index.php?rid=4620683&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1_suppl%2F75S%3Frss%3D1 This article focuses on the lessons learned from stochastic frontier analysis studies of U.S. hospitals, of which at least 27 have been published. A brief discussion of frontier techniques is provided, but a technical review of the literature is not included because overviews of estimation issues have been published recently. The primary focus is on the correlates of hospital inefficiency. In addition to examining the association of market pressures and hospital inefficiency, the authors also examined the relationship between inefficiency and hospital behavior (e.g., hospital exits) and inefficiency and other measures of hospital performance (e.g., outcome measures of quality). The authors found that consensus is emerging on the relationship of some factors to hospital efficiency; however,... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620683 Thu, 20 Jan 2011 00:00:00 +0100 4620683 http://www.medworm.com/index.php?rid=4620682&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1_suppl%2F55S%3Frss%3D1 In this article, a combination of data envelopment analysis, spreadsheet modeling and regression techniques is applied to a panel of nonprofit Washington State hospitals in an effort to determine whether (and if so, to what extent) inefficiency in one hospital cost center is shared with inefficiency in other cost centers. The findings suggest that a significant amount of inefficiency is shared across hospital cost centers. The authors further determine that certain cost centers contribute more to the overall performance of a given hospital than others. As such, managerial decisions and government policies designed to enhance hospital efficiency should be implemented differently, depending on the characteristics of the hospital in question. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620682 Thu, 20 Jan 2011 00:00:00 +0100 4620682 http://www.medworm.com/index.php?rid=4620681&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1_suppl%2F36S%3Frss%3D1 The efficiency of hospital services and patients’ access to hospitals are both important health care policy issues. In the past, research has relied on studying these topics separately. In this article, we measure both efficiency and access at the same time using data envelopment analysis (DEA). By including both the technically efficient use of resources, as well as the patients’ travel distances, we found increases in social efficiency when patients’ travel distances were taken into account. When compared with patients with nonurgent conditions, we found that patients suffering from conditions requiring urgent attention were treated at closer hospitals, increasing the social efficiency. Insurance coverage and hospital ownership were also examined. Our findings corrobora... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620681 Thu, 20 Jan 2011 00:00:00 +0100 4620681 http://www.medworm.com/index.php?rid=4620680&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1_suppl%2F20S%3Frss%3D1 This study evaluates the productivity changes for the Veterans Integrated Service Networks (VISNs) that the Veterans Health Administration (VHA) created, comparing performance in 1994 with that in 2004. This represents periods before and after the VHA in 1995 reconfigured provider units into 21 regionalized delivery systems and engaged in other important system innovations. Productivity is measured using the Malmquist Index approach (a longitudinal version of the data envelopment analysis [DEA]). Results indicate that the VISN restructuring generally produced improvements in overall productivity (Malmquist scores) and in VISN adaptations to structural/technological change. They also show that the VISNs overall did not produce "changes in efficiency," reflecting challenges they may have fac... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620680 Thu, 20 Jan 2011 00:00:00 +0100 4620680 http://www.medworm.com/index.php?rid=4620679&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1_suppl%2F3S%3Frss%3D1 Frontier techniques, including data envelopment analysis (DEA) and stochastic frontier analysis (SFA), have been used to measure health care provider efficiency in hundreds of published studies. Although these methods have the potential to be useful to decision makers, their utility is limited by both methodological questions concerning their application, as well as some disconnect between the information they provide and the insight sought by decision makers. The articles in this special issue focus on the application of DEA and SFA to hospitals with the hope of making these techniques more accurate and accessible to end users. This introduction to the special issue highlights the importance of measuring the efficiency of health care providers, provides a background on frontier techniques... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4620679 Thu, 20 Jan 2011 00:00:00 +0100 4620679 http://www.medworm.com/index.php?rid=4376451&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1%2F112%3Frss%3D1 Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b) its essential components, particularly when constructing measures.To address these issues, the authors propose a definition of integrated patient care that distinguishes it from integrated delivery organizations, acknowledging that integrated organizational structures and processes may fail to produce integrated patient care. The definition emphasizes patients’ central role as active participants in managing their own health by including patient centeredness as a key element of integrate... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376451 Thu, 20 Jan 2011 00:00:00 +0100 4376451 http://www.medworm.com/index.php?rid=4376450&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1%2F96%3Frss%3D1 Steep declines in pediatric antidepressant use were documented following the 2004 release of new safety information associating antidepressants with a risk of suicidality. The authors examine whether declines in pediatric antidepressant use were steeper among individuals with certain clinical or family characteristics. The authors find that declines in antidepressant use were associated with new (as compared with ongoing) treatment episodes. Although rates of antidepressant use were higher among children of college-educated parents prior to risk disclosures, these children were more likely to forgo antidepressant medication than children of less educated parents after risk disclosures. The authors find that both children with and without psychiatric impairment experienced declines in antid... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376450 Thu, 20 Jan 2011 00:00:00 +0100 4376450 http://www.medworm.com/index.php?rid=4376449&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1%2F75%3Frss%3D1 This study examined the relationship between electronic medical records (EMR) sophistication and the efficiency of U.S. hospital emergency departments (EDs). Using data from the 2006 National Hospital Ambulatory Medical Care Survey, survey-weighted ordinary least squares regressions were used to estimate the association of EMR sophistication with ED throughput and probability a patient left without treatment. Instrumental variables were used to test for the presence of endogeneity and reverse causality. Greater EMR sophistication had a mixed association with ED efficiency. Relative to EDs with minimal or no EMR, fully functional EMR was associated with 22.4% lower ED length of stay and 13.1% lower diagnosis/treatment time. However, the relationships varied by patient acuity level and diagn... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376449 Thu, 20 Jan 2011 00:00:00 +0100 4376449 http://www.medworm.com/index.php?rid=4376448&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1%2F56%3Frss%3D1 This study examines the impact of disenrolling from Medicaid/State Children’s Health Insurance Programs (SCHIP) on health care utilization and expenditures among children using the 1996-2005 Medical Expenditure Panel Survey data. Changes in expenditures and utilization upon Medicaid/SCHIP disenrollment were examined for two disenrollment groups, children who became uninsured and those who transitioned to private insurance; relative to a control group, those continuously enrolled in Medicaid/SCHIP during the study period. In multivariate analysis, a modified two-part model and difference-in-difference analytic approach were used. The dependent variables were changes in total expenditures and changes in utilization (i.e., well-child visits, physician visits, emergency room visits, hosp... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376448 Thu, 20 Jan 2011 00:00:00 +0100 4376448 http://www.medworm.com/index.php?rid=4376447&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F68%2F1%2F49%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376447 Thu, 20 Jan 2011 00:00:00 +0100 4376447 http://www.medworm.com/index.php?rid=4376446&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1%2F41%3Frss%3D1 This article (Devers, 2011) discusses possible reasons for lack of progress in some areas— related to the under-supply of well-trained qualitative researchers and more tangible demand for their research—and mechanisms for future improvement. To ensure a robust health services research toolbox, the field must take additional steps to provide stronger education and training in qualitative methods and more funding and publication opportunities. Given the rapidly changing health care system post the passage of national health reform and the chalresearch issues associated with it, the health services research and management field will not meet its future challenges with quantitative methods alone or with a half-empty toolbox. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376446 Thu, 20 Jan 2011 00:00:00 +0100 4376446 http://www.medworm.com/index.php?rid=4376445&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F68%2F1%2F34%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376445 Thu, 20 Jan 2011 00:00:00 +0100 4376445 http://www.medworm.com/index.php?rid=4376444&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F68%2F1%2F3%3Frss%3D1 This article examines the volume and characteristics of qualitative research articles published in nine major health services and management journals between 1998 and 2008. Qualitative research articles comprise 9% of research articles published in these journals. Although the publication rate of qualitative research articles has not kept pace with that of quantitative research articles, citation analysis suggests that qualitative research articles contribute comparably to the field’s knowledge base. A wide range of policy and management topics has been examined using qualitative methods. Case study designs, interviews, and documentary sources were the most frequently used methods. Half of qualitative research articles provided little or no detail about key aspects the study’s ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4376444 Thu, 20 Jan 2011 00:00:00 +0100 4376444 http://www.medworm.com/index.php?rid=4157690&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F6%2F722%3Frss%3D1 This study investigates conventional medicine utilization by wellness-motivated, complementary and alternative medicine (CAM) consumers. While CAM consumers are typically characterized as high health care utilizers, negative correlations have been found between CAM-based wellness programs and the consumption of conventional medical care. We use a nationally representative sample to analyze both illness- and wellness-motivated CAM users, with an interest in whether CAM therapies used for wellness replace conventional medicine, thus potentially offering cost offsets. Results indicate that motivation for CAM use is neither associated with a lower probability nor a lower rate of conventional medicine utilization. Increasingly, individuals, workplaces, and governments incorporate wellness progr... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157690 Thu, 11 Nov 2010 00:00:00 +0100 4157690 http://www.medworm.com/index.php?rid=4157689&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F6%2F707%3Frss%3D1 Itemized deduction for medical expenses has existed in one form or another for more than 60 years. One justification for this tax deduction is that it reduces the burden for taxpayers with catastrophic expenses. Currently it shields more out-of-pocket spending on health care from taxes than any other tax provision. Based on a repeated cross section from 1999 to 2005 and a 5-year panel of tax returns, we find that filers aged 65 years or older claim the deduction more often, deduct larger amounts, and do so more persistently than younger taxpayers. Augmenting tax data with information from the MEPS, we find that no more than 41% of all tax units with non—tax preferred medical expenditures exceeding 10% of income claimed the deduction in 2005. Even for those claiming the deduction, the... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157689 Thu, 11 Nov 2010 00:00:00 +0100 4157689 http://www.medworm.com/index.php?rid=4157688&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F6%2F694%3Frss%3D1 This study describes and analyzes trends in aggregate asset structure between NFP and investor-owned (IO) hospitals during the post-capital-based prospective payment system implementation period, providing the first documentation of long-term trends in hospital investment. The authors find hospitals’ aggregate asset structure differs significantly based on ownership, size, and profitability. For both NFP and IO hospitals, financial securities have remained consistent over time, while fixed asset representation has declined in IO hospitals. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157688 Thu, 11 Nov 2010 00:00:00 +0100 4157688 http://www.medworm.com/index.php?rid=4157687&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F6%2F676%3Frss%3D1 The Medicare Fee Schedule with payments for thousands of visits and procedures is updated periodically for the work component of changes in physician relative work. Three 5-year reviews of physician work by Medicare have been biased against finding productivity gains and reductions in physician work relative values. The authors present four studies showing shorter physician times with patients in their offices and in the operating room, increases in surgeons’ self-reported total work in spite of declining operating room times, and growing numbers of costly handoffs to nonsurgeons, while surgeons receive full payment for postoperative follow-up with patients. Substantial savings exist in the fee schedule if productivity gains from greater delegation to ancillary staff and specialists,... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157687 Thu, 11 Nov 2010 00:00:00 +0100 4157687 http://www.medworm.com/index.php?rid=4157686&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F6%2F657%3Frss%3D1 This article investigates the longitudinal predictors of these coverage gaps and disenrollment from age 16 to 23 years. Cox regression analyses estimated predictors of time until the first loss of coverage for 180 days or more, and time until final disenrollment with no subsequent reenrollment. Females were much more likely to regain and retain coverage after initial loss. Funding source and diagnoses predicted Medicaid retention differentially by gender. For both genders, funding through Social Security Income or a diagnosis of Mental Retardation/ Developmental Disabilities was related to Medicaid retention. Disenrollment especially affected males precisely at their 18th and 19th birthdays. Nearly one third of females qualified for Medicaid because of pregnancy. Eligibility guidelines rel... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157686 Thu, 11 Nov 2010 00:00:00 +0100 4157686 http://www.medworm.com/index.php?rid=4157685&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F6%2F627%3Frss%3D1 Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian’s framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident’s welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157685 Thu, 11 Nov 2010 00:00:00 +0100 4157685 http://www.medworm.com/index.php?rid=3964436&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5%2F609%3Frss%3D1 Indexes of prenatal care adequacy distinguish care that includes more than the recommended number of visits because extra visits may signal a high-risk pregnancy. Using Natality files from 1985 to 2004, the authors found such "superadequate" care increased from 19.5% of pregnancies in 1985 to 30.0% in 2004. Although there were dramatic changes in the demographics of childbearing over the same 20 years, those changes do not explain the increase in extra prenatal visits: Superadequate care increased within every stratum defined by maternal birthplace, race, age, education, gravidity, marital status, and multiple birth. Had the demographics of childbearing not changed since 1985, the superadequate rate would be just as high in 2004. Although randomized controlled trials have found that reduce... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3964436 Tue, 14 Sep 2010 06:17:50 +0100 3964436 http://www.medworm.com/index.php?rid=3964435&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5%2F590%3Frss%3D1 Strengthening safety climate is recognized as a necessary strategy for improving patient safety. Yet there is little empirical evidence linking hospitals’ safety climate with safety outcomes.The authors explored the potential relationship between safety climate and Veterans Health Administration hospital safety performance using the Patient Safety Indicator (PSI) rates. Safety climate survey data were merged with hospital discharge data to calculate PSIs. Linear regressions examined the relationship between hospitals’ safety climate and dimensions of safety climate with individual PSIs and a PSI composite measure, controlling for organizational-level variables. Safety climate overall was not related to the PSIs or to the PSI composite, although a few individual dimensions of sa... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3964435 Tue, 14 Sep 2010 06:17:50 +0100 3964435 http://www.medworm.com/index.php?rid=3964434&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5%2F574%3Frss%3D1 This article describes the results of qualitative interviews with hospital executives to assess the potential impact that such programs would have on hospitals and their minority patients. The authors find that executives have significant concerns regarding funding mechanisms and implementation costs, financial risks for safety net hospitals, and resource constraints, as well as how such programs can be used to create incentives to care for minority patients. The findings suggest that payers should be hesitant to use pay-for-performance as a mechanism for reducing disparities until a wide variety of concerns about the design of such programs can be addressed. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3964434 Tue, 14 Sep 2010 06:17:50 +0100 3964434 http://www.medworm.com/index.php?rid=3964433&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5%2F555%3Frss%3D1 This study used the Online Survey, Certification, and Reporting (OSCAR) staffing data for freestanding Florida nursing homes between the years 1999 and 2004. Piecewise regression growth curve models were investigated to test whether the percentage of Medicaid residents is associated with change in indirect-care staffing levels. The number of indirect-care staff hours per 100 residents declined significantly following the mandated increase in nursing staff, particularly among facilities with a low percentage of Medicaid residents. This may have stemmed from a partial transfer of indirect-care to CNAs and was exacerbated in facilities that received less additional reimbursement to pay for CNA increases. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3964433 Tue, 14 Sep 2010 06:17:50 +0100 3964433 http://www.medworm.com/index.php?rid=3964432&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5%2F528%3Frss%3D1 The authors review experimental and nonexperimental causal inference methods, focusing on assumptions for the validity of instrumental variables and propensity score (PS) methods. They provide guidance in four areas for the analysis and reporting of PS methods in medical research and selectively evaluate mainstream medical journal articles from 2000 to 2005 in the four areas, namely, examination of balance, overlapping support description, use of estimated PS for evaluation of treatment effect, and sensitivity analyses. In spite of the many pitfalls, when appropriately evaluated and applied, PS methods can be powerful tools in assessing average treatment effects in observational studies. Appropriate PS applications can create experimental conditions using observational data when randomized... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3964432 Tue, 14 Sep 2010 06:17:50 +0100 3964432 http://www.medworm.com/index.php?rid=3964431&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5%2F503%3Frss%3D1 Previous reviews of research on electronic health record (EHR) data quality have not focused on the needs of quality measurement. The authors reviewed empirical studies of EHR data quality, published from January 2004, with an emphasis on data attributes relevant to quality measurement. Many of the 35 studies reviewed examined multiple aspects of data quality. Sixty-six percent evaluated data accuracy, 57% data completeness, and 23% data comparability. The diversity in data element, study setting, population, health condition, and EHR system studied within this body of literature made drawing specific conclusions regarding EHR data quality challenging. Future research should focus on the quality of data from specific EHR components and important data attributes for quality measurement such... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3964431 Tue, 14 Sep 2010 06:17:50 +0100 3964431 http://www.medworm.com/index.php?rid=4157696&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5_suppl%2F268S%3Frss%3D1 Health information technology (health IT) has potential for facilitating quality improvement and reducing quality disparities found in underresourced settings (URSs). With this systematic literature review, complemented by key informant interviews, the authors sought to identify evidence regarding health IT and quality outcomes in URSs. The review included 105 peer-reviewed studies (2004-2009) in all settings. Only 15 studies included URSs, and 8 focused on URSs. Based on literature across settings, most evidence was available for quality impact of order entry, clinical decision support systems, and computerized reminders. Study designs were predominantly quasi-experimental (37%) or descriptive (35%); 90% of the studies focused on the microsystem level of quality improvement, indicating a ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157696 Mon, 13 Sep 2010 00:00:00 +0100 4157696 http://www.medworm.com/index.php?rid=4157695&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5_suppl%2F246S%3Frss%3D1 Effective communication between providers and patients has been linked to improved outcomes. Previous reviews of quality improvement strategies, including health information technology (health IT), have not focused on the needs of low-income children. The authors conducted a systematic review of the literature on studies of communication surrounding the care of low-income children, with an emphasis on interventions and health IT.The search yielded six studies that focused on low-income children; three of the studies used health IT. Key informant interviews provided insight to the current use of health IT for provider—patient communication in geographically diverse, underresourced settings.The authors identify gaps between existing literature and clinical practice. Future research sho... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157695 Mon, 13 Sep 2010 00:00:00 +0100 4157695 http://www.medworm.com/index.php?rid=4157694&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5_suppl%2F231S%3Frss%3D1 Disparities in provider—patient communication have been shown to exist among Asian Americans, especially those who are low-income and have limited English proficiency. These disparities have resulted in unmet health care needs and poor quality care. To identify strategies for improving provider—patient communication in this population, we conducted a systematic review of the literature and in-depth interviews with key informants. Little published literature on interventions focused on Asian Americans was found. Most interventions were conducted among White populations and occurred in the waiting room before patients’ visits with their providers. Interventions ranged from a leaflet encouraging patients to ask more questions, to more intensive face-to-face coaching before o... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157694 Mon, 13 Sep 2010 00:00:00 +0100 4157694 http://www.medworm.com/index.php?rid=4157693&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5_suppl%2F198S%3Frss%3D1 This study examined what innovative strategies, including the use of health information technology (health IT), have been or can be used to reduce disparities in prenatal care quality in underresourced settings. Based on literature review and key informant interviews, the authors identified 17 strategies that have been or can be used to (a) increase access to timely prenatal care, (b) improve the content of prenatal care, and (c) enhance the organization and delivery of prenatal care. Health IT can be used to (a) increase consumer awareness about the importance of preconception and early prenatal care, facilitate spatial mapping of access gaps, and improve continuity of patient records; (b) support collaborative quality improvement, facilitate performance measurement, enhance health promot... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157693 Mon, 13 Sep 2010 00:00:00 +0100 4157693 http://www.medworm.com/index.php?rid=4157692&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5_suppl%2F163S%3Frss%3D1 This article reviews the effectiveness of health care interventions using health IT to improve diabetes process of care and intermediate diabetes outcomes in African American and Hispanic patients. Health IT interventions have addressed patient, provider, and system challenges in the provision of diabetes care but require further testing in minority patient populations to evaluate their effectiveness in improving diabetes outcomes and reducing diabetes-related complications. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157692 Mon, 13 Sep 2010 00:00:00 +0100 4157692 http://www.medworm.com/index.php?rid=4157691&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F5_suppl%2F155S%3Frss%3D1 This article outlines the process, findings, and key recommendations of this expert workshop. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=4157691 Mon, 13 Sep 2010 00:00:00 +0100 4157691 http://www.medworm.com/index.php?rid=3766490&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F67%2F4%2F492%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766490 Mon, 19 Jul 2010 14:59:28 +0100 3766490 http://www.medworm.com/index.php?rid=3766489&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F67%2F4%2F485%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766489 Mon, 19 Jul 2010 14:59:28 +0100 3766489 http://www.medworm.com/index.php?rid=3766488&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F67%2F4%2F476%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766488 Mon, 19 Jul 2010 14:59:28 +0100 3766488 http://www.medworm.com/index.php?rid=3766487&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4%2F450%3Frss%3D1 This study examined data from the 2005-2006 National Survey of Children with Special Health Care Needs to assess the relationship among children with asthma between a reported medical home and emergency department (ED) use. The authors used 21 questions to measure 6 medical home components: personal doctor/nurse, family-centered, compassionate, culturally effective and comprehensive care, and effective care coordination. Weighted zero-inflated Poisson regression analyses assessed the independent effects of having a medical home on annual number of child ED visits while controlling for child and parental characteristics, and the differential likelihood of securing a medical home. Nearly half (49.9%) of asthmatic children had a medical home. Receiving primary care in a medical home was assoc... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766487 Mon, 19 Jul 2010 14:59:28 +0100 3766487 http://www.medworm.com/index.php?rid=3766486&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4%2F431%3Frss%3D1 This study examined whether environmental factors and practice characteristics influence the existence of patient-centered medical home elements in family practices in Virginia. The study used multiple secondary data sets to measure the external environment and a survey of family practices to enumerate and describe medical home elements and practice environment. Results show a positive association between organizational slack, organizational relationships, and stakeholder expectations on the existence of medical home elements. A negative association was found between competition and medical home elements. Medicare and managed care penetration were not associated with medical home elements. The ability or willingness, or both, of family practices to innovate along the patient-centered medic... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766486 Mon, 19 Jul 2010 14:59:28 +0100 3766486 http://www.medworm.com/index.php?rid=3766485&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4%2F412%3Frss%3D1 The Medical Services Initiative program—a safety net—based system of care— in Orange County included assignment of uninsured, low-income residents to a patient-centered medical home. The medical home provided case management, a team-based approach for treating disease, and increased access to primary and specialty care among other elements of a patient-centered medical home. Providers were paid an enhanced fee and pay-for-performance incentives to ensure delivery of comprehensive treatment. Medical Services Initiative enrollees who were assigned to a medical home for longer time periods were less likely to have any emergency room (ER) visits or multiple ER visits. Switching medical homes three or more times was associated with enrollees being more likely to have any ER vi... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766485 Mon, 19 Jul 2010 14:59:28 +0100 3766485 http://www.medworm.com/index.php?rid=3766484&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4%2F393%3Frss%3D1 The medical home is a potentially transformative strategy to address issues of access, quality, and efficiency in the delivery of health care in the United States. While numerous organizations support a physician-driven definition, it is by no means the universally accepted definition. Several professional groups, payers, and researchers have offered differing, or nuanced, definitions of medical homes. This lack of consensus has contributed to uncertainty among providers about the medical home. We conducted a systematic review of the literature on the medical home and identified 29 professional, government, and academic sources offering definitions. While consensus appears to exist around a core of selected features, the medical home means different things to different people. The variatio... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766484 Mon, 19 Jul 2010 14:59:28 +0100 3766484 http://www.medworm.com/index.php?rid=3766483&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F67%2F4%2F383%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766483 Mon, 19 Jul 2010 14:59:28 +0100 3766483 http://www.medworm.com/index.php?rid=3766498&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F67%2F4_suppl%2F141S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766498 Mon, 19 Jul 2010 14:58:55 +0100 3766498 http://www.medworm.com/index.php?rid=3766497&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F67%2F4_suppl%2F126S%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766497 Mon, 19 Jul 2010 14:58:55 +0100 3766497 http://www.medworm.com/index.php?rid=3766496&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4_suppl%2F102S%3Frss%3D1 A challenge in the adoption of long-term care (LTC) policy reform is the number of constituency groups active in LTC and historical antagonism among these groups regarding critical issues such as LTC financing and regulation. As part of a national survey of LTC specialists, the authors asked previously identified specialists to nominate other "experts" with known or demonstrable experience in LTC. As a proxy for potential information exchange, data about nominations were used to construct and describe the networks of LTC specialists representing consumer advocates, provider representatives, public officials, policy experts, and others. Associations between network characteristics and attitudes about LTC policy reform were also examined. Individuals tended to nominate other people within th... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766496 Mon, 19 Jul 2010 14:58:55 +0100 3766496 http://www.medworm.com/index.php?rid=3766495&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4_suppl%2F82S%3Frss%3D1 This article reports the results of the Commonwealth Fund Long-Term Care Opinion Leader Survey (N = 1,147) on issues related to supporting HCBS. Respondents expressed strong enthusiasm for rebalancing of the long-term care system toward HCBS. In particular, respondents supported system-based approaches for this expansion, with the majority indicating that greater care coordination was the single most preferred approach for rebalancing the system, helping consumers make informed long-term care choices, and supporting caregivers. Building on the long-term care specialists’ enthusiasm for system-based reforms, we encourage state policy makers to pursue HCBS models that are linked to Medicare, engage primary care physicians, and are based on rigorous evaluations. (Source: Medical Care Re... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766495 Mon, 19 Jul 2010 14:58:55 +0100 3766495 http://www.medworm.com/index.php?rid=3766494&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4_suppl%2F65S%3Frss%3D1 A decade-long grassroots movement aims to deinstitutionalize nursing home (NH) environments and individualize care. Coined "NH Culture Change" the movement is often described by its resident-centered/directed care focus. While empirical data of "culture change’s" costs and benefits are limited, it is broadly viewed as beneficial and widely promoted. Still, debate abounds regarding barriers to its adoption. We used data from a Web-based survey of 1,147 long-term care specialists (including NH and other providers, consumers/advocates, state and federal government officials, university/academic, researchers/consultants, and others) to better understand factors associated with perceived barriers. Long-term care specialists view the number-one barrier to adoption differently depending on ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766494 Mon, 19 Jul 2010 14:58:55 +0100 3766494 http://www.medworm.com/index.php?rid=3766493&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4_suppl%2F38S%3Frss%3D1 This article reports the results of a survey of 1,147 long-term care specialists on issues related to the government’s performance in assuring quality and improving care. With the exception of providers, more than half of specialists ranked the quality of the average nursing home as fair or poor; home health agencies and even assisted-living facilities fared only somewhat better. Yet despite the perceived ineffectiveness of the current regime, the majority of specialists expressed a general willingness to continue pursuing more stringent and enhanced enforcement and to proceed down the same path with assisted-living facilities. Furthermore, while most were not sanguine about public reporting, the majority favored pay-for-performance, even though both rely on the same information. In ... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766493 Mon, 19 Jul 2010 14:58:55 +0100 3766493 http://www.medworm.com/index.php?rid=3766492&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4_suppl%2F16S%3Frss%3D1 Deficiencies in current long-term care (LTC) financing models are substantial and must be addressed if the nation is going to meet the needs of the growing population of frail and disabled elders. Because debate over reforming LTC financing has traditionally focused on the relative roles of the public and private sectors, this article examines what characteristics predispose LTC specialists to weigh one approach— public or private—more than the other. Data are derived from a Web-based survey of 1,147 individuals with known or demonstrable experience with LTC, including consumer advocates, provider representatives, policy experts, and public officials. Results suggest that support for spurring private sector mechanisms, bolstering the government’s role, and reforming Medic... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766492 Mon, 19 Jul 2010 14:58:55 +0100 3766492 http://www.medworm.com/index.php?rid=3766491&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F4_suppl%2F3S%3Frss%3D1 The Commonwealth Fund Survey of Long-Term Care of Specialists was administered via the World Wide Web from September 2007 through March 2008. The primary purpose was to characterize the views of those with known or demonstrable experience and expertise with at least one aspect of long-term care. Among 2,577 potential respondents, 1,147 completed the entire survey for an overall response rate of 44.5%. This special supplement of Medical Care Research and Review uses data collected from the survey to explore several issue areas, namely, reforming long-term care financing, improving government oversight, adopting nursing home culture change, and rebalancing long-term care away from institutions toward home- and community-based services. Analyses documenting the opinion networks of long-term c... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3766491 Mon, 19 Jul 2010 14:58:55 +0100 3766491 http://www.medworm.com/index.php?rid=3572571&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F3%2F364%3Frss%3D1 Whereas numerous policies have been adopted to improve quality of care in nursing homes over the past several decades—with varying degrees of success—health care payment has been a largely untapped but potentially powerful policy tool to improve quality of care. Recently, however, payers have invested significant resources in the development and implementation of pay-for-performance (P4P) programs for nursing homes. The authors present results from a survey of state Medicaid agencies documenting the use and structure of P4P in nursing homes. Although the number of states that are implementing nursing home P4P is growing, the structure of these incentives varies across states, and little evidence exists to guide the planning or implementation of these initiatives. (Source: Medic... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3572571 Mon, 17 May 2010 17:05:31 +0100 3572571 http://www.medworm.com/index.php?rid=3572570&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F3%2F342%3Frss%3D1 We investigate the extent to which antidepressant use among adolescents varies across racial and ethnic subgroups. Using a representative sample of U.S. adolescents, we find that non-Hispanic White adolescents are over twice as likely as Hispanic adolescents, and over five times as likely as non-Hispanic Black adolescents to use antidepressants. Results from a decomposition analysis indicate that racial/ethnic differences in characteristics, including household income, parental education, health insurance, and having a usual source of care explain between one half and two thirds of the gap in antidepressant use between Hispanics and non-Hispanic Whites. In contrast, none of the gap between Whites and Blacks in antidepressant use is explained by differences in observed characteristics. Furt... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3572570 Mon, 17 May 2010 17:05:31 +0100 3572570 http://www.medworm.com/index.php?rid=3572569&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F3%2F321%3Frss%3D1 This study tested the association between hospital structural characteristics—teaching status, bedsize, and nurse staffing—and potentially preventable adverse events. The authors calculated 14 Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) and a PSI composite, using discharge databases from VA and nonfederal hospitals. This study compared the likelihood of PSI events in hospitals, controlling for structural and other characteristics, including patients’ case-mix. Additional controls were employed to account for differences in VA versus nonfederal patients and data. The study found some associations, most notably a positive (unfavorable) association between status as a major teaching hospital and six PSIs. However, for most PSIs, the authors fo... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3572569 Mon, 17 May 2010 17:05:31 +0100 3572569 http://www.medworm.com/index.php?rid=3572568&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F3%2F301%3Frss%3D1 The use of evidence-based care management processes (CMPs) in physician practice is an important component of delivery-system reform.The authors used data from a 2006-2007 national study of large physician organizations—medical groups and independent practice associations (IPAs) to determine the extent to which organizations use CMPs, and to identify external (market) influences and organizational capabilities associated with CMP use. The study found that physician organizations use about half of recommended CMPs, most commonly disease registries, specially trained patient educators, and performance feedback to physicians. Physician organizations that reported participating in quality improvement programs, having a patient-centered focus, and being owned by a hospital or health maint... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3572568 Mon, 17 May 2010 17:05:31 +0100 3572568 http://www.medworm.com/index.php?rid=3572567&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Freprint%2F67%2F3%2F297%3Frss%3D1 (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3572567 Mon, 17 May 2010 17:05:31 +0100 3572567 http://www.medworm.com/index.php?rid=3572565&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F3%2F275%3Frss%3D1 In this study, the authors determine the impact of providing a framework for understanding quality on the comprehension and salience of quality information. The study uses an experimental design and tests the effect of providing a framework for describing quality of care, as well as plain language descriptions of quality indicators. The findings indicate that when providing a framework and using plain language to describe quality indicators, consumers were better able to understand and to see greater value in the information, as compared to participants who saw a report that had neither of these attributes. The policy and practice implications are discussed. (Source: Medical Care Research and Review) Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3572565 Mon, 17 May 2010 17:05:31 +0100 3572565 http://www.medworm.com/index.php?rid=3572564&cid=s_31290_51_f&fid=31290&url=http%3A%2F%2Fmcr.sagepub.com%2Fcgi%2Fcontent%2Fabstract%2F67%2F3%2F251%3Frss%3D1 In this study, the authors review existing cost-effectiveness studies of primary care depression treatments, classify them into categories, translate the results into net benefit terms, and assess whether more costly programs generate greater net benefit. The authors find that interventions that provide training to primary care teams in how to manage depression most consistently produce net benefits, with more costly interventions of this type generating larger net benefits than less costly interventions. Collaborative care interventions, which add specialized staff to primary care practices, and therapy interventions, in which clinicians are trained to provide therapy, also generate net social benefits at conventional valuations of quality-adjusted life years. (Source: Medical Care Resear... Medical Care Research and Review journals http://www.medworm.com/rss/comments.php?id=3572564 Mon, 17 May 2010 17:05:31 +0100 3572564 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