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Assessing Heterogeneity of Treatment Effects: Are Authors Misinterpreting Their Results?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To determine whether investigations of heterogeneity of treatment effects (HTE) in randomized-controlled trials (RCTs) are prespecified and whether authors' interpretations of their analyses are consistent with the objective evidence. Trials published in Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine in 1994, 1999, and 2004. We reviewed 87 RCTs that reported formal tests for statistical interaction or heterogeneity (HTE analyses), derived from a probability sample of 541 articles. We recorded reasons for performing HTE analysis;...
Source: Health Services Research - November 20, 2009 Category: Health Management Authors: Erik Fernandez y Garcia, Hien Nguyen, Naihua Duan, Nicole B. Gabler, Richard L. Kravitz Source Type: journals

The Impact of Malpractice Liability Claims on Obstetrical Practice PatternsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This paper examines whether malpractice claims have any impact on obstetrical practice patterns (C-section rates) and physician delivery volume. Secondary data from the 1992[ndash]2000 Florida Hospital Inpatient Discharge File, the Florida Medical Professional Liability Insurance Claims File, and the American Medical Association's Master File on physician characteristics. The effects of malpractice claims on C-section rates and physician delivery volume were estimated using panel data and a fixed-effects multivariate model. Variables were constructed from each data source and merged into a single panel dataset using consis...
Source: Health Services Research - November 19, 2009 Category: Health Management Authors: Gilbert W. Gimm Source Type: journals

Electronic Prescribing at the Point of Care: A Time–Motion Study in the Primary Care SettingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To evaluate the impact of an ambulatory computerized provider order entry (CPOE ) system on the time efficiency of prescribers. Two primary aims were to compare prescribing time between (1) handwritten and electronic (e-) prescriptions and (2) e-prescriptions using differing hardware configurations. Primary data on prescribers/staff were collected (2005[ndash]2007) at three primary care clinics in a community based, multispecialty health system. This was a quasi-experimental, direct observation, time[ndash]motion study conducted in two phases. In phase 1 (n=69 subjects), each site used a unique combination of CPOE software...
Source: Health Services Research - November 19, 2009 Category: Health Management Authors: Emily Beth Devine, William Hollingworth, Ryan N. Hansen, Nathan M. Lawless, Jennifer L. Wilson-Norton, Diane P. Martin, David K. Blough, Sean D. Sullivan Source Type: journals

The "Nursing Home Compare" Measure of Urinary/Fecal Incontinence: Cross-Sectional Variation, Stability over Time, and the Impact of Case MixEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To assess the impact of facility case mix on cross-sectional variations and short-term stability of the "Nursing Home Compare" incontinence quality measure (QM) and to determine whether multivariate risk adjustment can minimize such impacts. Retrospective analyses of the 2005 national minimum data set (MDS) that included approximately 600,000 long-term care residents in over 10,000 facilities in each quarterly sample. Mixed logistic regression was used to construct the risk-adjusted QM (nonshrinkage estimator). Facility-level ordinary least-squares models and adjusted R2 were used to estimate the impact of case mix on cros...
Source: Health Services Research - October 30, 2009 Category: Health Management Authors: Yue Li, John Schnelle, William D. Spector, Laurent G. Glance, Dana B. Mukamel Source Type: journals

Commentary: What's in a Name? Statistical Discrimination and Disparities ResearchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Health Services Research)
Source: Health Services Research - October 29, 2009 Category: Health Management Authors: Timothy P. Hofer Source Type: journals

Commentary: Response to Hofer CommentaryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Health Services Research)
Source: Health Services Research - October 29, 2009 Category: Health Management Authors: Nancy Maserejian, Karen Lutfey, Carol Link, John McKinlay Source Type: journals

Use of Interpreters by Physicians Treating Limited English Proficient Women with Breast Cancer: Results from the Provider Survey of the Los Angeles Women's Health StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Little is known about how cancer physicians communicate with limited English proficient (LEP) patients. We studied physician-reported use and availability of interpreters. A 2004 survey was fielded among physicians identified by a population-based sample of breast cancer patients. Three hundred and forty-eight physicians completed mailed surveys (response rate: 77 percent) regarding the structure and organization of care. We used logistic regression to analyze use and availability of interpreters. Most physicians reported treating LEP patients. Among physicians using interpreters within the last 12 months, 42 percent repor...
Source: Health Services Research - October 29, 2009 Category: Health Management Authors: Danielle E. Rose, Diana M. Tisnado, Jennifer L. Malin, May L. Tao, Melinda A. Maggard, John Adams, Patricia A. Ganz, Katherine L. Kahn Source Type: journals

Obstetric Complications in Women with Diagnosed Mental Illness: The Relative Success of California's County Mental Health SystemEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine disparities in serious obstetric complications and quality of obstetric care during labor and delivery for women with and without mental illness. Linked California hospital discharge (2000[ndash]2001), birth, fetal death, and county mental health system (CMHS) records. This population-based, cross-sectional study of 915,568 deliveries in California, calculated adjusted odds ratios (AORs) for obstetric complication rates for women with a mental illness diagnosis (treated and not treated in the CMHS) compared with women with no mental illness diagnosis, controlling for sociodemographic, delivery hospital type, and...
Source: Health Services Research - October 29, 2009 Category: Health Management Authors: Dorothy Thornton, Sylvia Guendelman, Nap Hosang Source Type: journals

The Value of Specialty Oncology DrugsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To estimate patients' elasticity of demand, willingness to pay, and consumer surplus for five high-cost specialty medications treating metastatic disease or hematologic malignancies. Claims data from 71 private health plans from 1997 to 2005. This is a revealed preference analysis of the demand for specialty drugs among cancer patients. We exploit differences in plan generosity to examine how utilization of specialty oncology drugs varies with patient out-of-pocket costs. We extracted key variables from administrative health insurance claims records. A 25 percent reduction in out-of-pocket costs leads to a 5 percent increa...
Source: Health Services Research - October 29, 2009 Category: Health Management Authors: Dana P. Goldman, Anupam B. Jena, Darius N. Lakdawalla, Jennifer L. Malin, Jesse D. Malkin, Eric Sun Source Type: journals

Predictors of Adequate Depression Treatment among Medicaid-Enrolled AdultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We examined rates and predictors of minimally adequate psychotherapy and pharmacotherapy among adults with a new depression treatment episode during the study period (N=1,098). Many depressed adults received either minimally adequate psychotherapy or pharmacotherapy. Black individuals and individuals who began their depression treatment episode with an inpatient psychiatric stay for depression were markedly less likely to receive minimally adequate psychotherapy and more likely to receive inadequate treatment. Racial minorities and individuals discharged from inpatient treatment for depression are at risk for receiving ina...
Source: Health Services Research - October 29, 2009 Category: Health Management Authors: Carrie Farmer Teh, Mark J. Sorbero, Mark J. Mihalyo, Jane N. Kogan, James Schuster, Charles F. Reynolds III, Bradley D. Stein Source Type: journals

SCHIP's Impact on Dependent Coverage in the Small-Group Health Insurance MarketEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This study estimates a two-stage least squares (2SLS) model for four insurance outcomes that instruments for SCHIP and Medicaid eligibility. Separate models are estimated for small group markets (firms with fewer than 25 employees), small businesses (firms under 500 employees), and large firms (firms 500 employees and above). We extracted data from the 1996[ndash]2007 CPS for children in households with at least one worker. The SCHIP expansions decreased the percentage of uninsured dependents in the small group market by 7.6 percentage points with negligible crowd-out in the small group and no significant effect on private...
Source: Health Services Research - October 15, 2009 Category: Health Management Authors: Eric E. Seiber, Curtis S. Florence Source Type: journals

Has Pay-for-Performance Decreased Access for Minority Patients?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine whether the CMS and Premier Inc. Hospital Quality Incentive Demonstration (PHQID), a hospital-based pay-for-performance (P4P) and public quality reporting program, caused participating hospitals (1) to avoid treating minority patients diagnosed with acute myocardial infarction (AMI), heart failure, and pneumonia and (2) to avoid providing coronary artery bypass graft (CABG) to minority patients diagnosed with AMI. One hundred percent Medicare inpatient claims, denominator files, and provider of service files from 2000 to 2006. We test for differences in the conditional probability of receiving care at PHQID hosp...
Source: Health Services Research - October 14, 2009 Category: Health Management Authors: Andrew M. Ryan Source Type: journals

The Utility of the State Buy-In Variable in the Medicare Denominator File to Identify Dually Eligible Medicare-Medicaid Beneficiaries: A Validation StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To compare the adequacy of the state buy-in variable (SBI) in the Medicare denominator file to identify dually eligible patients. We used linked Medicare and Medicaid data from Michigan and Ohio for elders diagnosed with incident breast, prostate, or colorectal cancer between 1996 and 2001. Using the Medicaid enrollment file as the "gold standard," we assessed the number of duals from Medicare files in cross-sectional and longitudinal analyses. Data for the study population were linked with Medicare and Medicaid files using patient identifiers. Sensitivity was low (74.2 percent, 95 percent confidence interval [CI]: 72.7, 7...
Source: Health Services Research - October 14, 2009 Category: Health Management Authors: Siran M. Koroukian, Bassam Dahman, Glenn Copeland, Cathy J. Bradley Source Type: journals

Does Major Illness Cause Financial Catastrophe?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We examine the financial impact of major illnesses on the near-elderly and how this impact is affected by health insurance. We use RAND Corporation extracts from the Health and Retirement Study from 1992 to 2006.1 Our dependent variable is the change in household assets, excluding the value of the primary home. We use triple difference median regressions on a sample of newly ill/uninsured near elderly (under age 65) matched to newly ill/insured near elderly. We also include a matched control group of households whose members are not ill. Controlling for the effects of insurance status and illness, we find that the median h...
Source: Health Services Research - October 13, 2009 Category: Health Management Authors: Keziah Cook, David Dranove, Andrew Sfekas Source Type: journals

Trends in Hospital Cost and Revenue, 1994–2005: How Are They Related to HMO Penetration, Concentration, and For-Profit Ownership?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Analyze trends in hospital cost and revenue, as well as price and quantity (1994[ndash]2005) as a function of health maintenance organization (HMO) penetration, HMO concentration, and for-profit (FP) HMO market share. Medicare hospital cost reports, AHA Annual Surveys, HMO data from Interstudy, and other supplemental data. A retrospective study of all short-term, general, nonfederal hospitals in metropolitan statistical areas (MSAs) in the United States from 1994 to 2005, using hospital/MSA fixed-effects translog regression models. A 10 percentage point increase in HMO enrollment is associated with 4.1[ndash]4.2 percent re...
Source: Health Services Research - October 12, 2009 Category: Health Management Authors: Yu-Chu Shen, Vivian Y. Wu, Glenn Melnick Source Type: journals

Show Us the Money: Lessons in Transparency from State Pharmaceutical Marketing Disclosure LawsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To assess legislation requiring drug companies to report gifts to providers, and to evaluate the information obtained. Data included legislation in Vermont, Minnesota, Maine, Massachusetts, West Virginia, and the District of Columbia, and company disclosure data from Vermont. We evaluated the strengths and weaknesses of state legislation. We also analyzed 4 years of company disclosures from Vermont, assessing the value and distribution of industry[ndash]provider exchanges and identifying emerging trends in companies' practices. State legislation is publically available. We obtained Vermont's data through requests to the st...
Source: Health Services Research - October 12, 2009 Category: Health Management Authors: Susan Chimonas, Natassia M. Rozario, David J. Rothman Source Type: journals

The Role of Monetary and Nonmonetary Incentives on the Choice of Practice Establishment: A Stated Preference Study of Young Physicians in GermanyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The study aimed to quantify the preferences of young physicians for different attributes relevant to practice establishment in Germany. Qualitative in-depth interviews of 22 physicians were conducted to identify relevant practice attributes. Based on this information, a questionnaire was developed containing a discrete choice experiment comprised of a "best[ndash]worst scaling" (BWS) task. It was mailed to a representative sample of 14,939 young physicians who were close to making a decision regarding practice establishment. Regression analysis was used to estimate utility weights quantifying physicians' preferences for pr...
Source: Health Services Research - September 24, 2009 Category: Health Management Authors: Oliver H. Günther, Beate Kürstein, Steffi G. Riedel-Heller, Hans-Helmut König Source Type: journals

Preventive HIV Vaccine Acceptability and Behavioral Risk Compensation among a Random Sample of High-Risk Adults in Los Angeles (LA VOICES)Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To assess HIV vaccine acceptability among high-risk adults in Los Angeles. Sexually transmitted disease clinics, needle/syringe exchange programs, Latino community health/HIV prevention programs. Cross-sectional survey using conjoint analysis. Participants were randomly selected using three-stage probability sampling. Sixty-minute structured interviews. Participants rated acceptability of eight hypothetical vaccines, each with seven dichotomous attributes, and reported post-vaccination risk behavior intentions. Participants (n=1164; 55.7 percent male, 82.4 percent ethnic minority, mean age=37.4 years) rated HIV vaccine acc...
Source: Health Services Research - September 23, 2009 Category: Health Management Authors: Peter A. Newman, Sung-Jae Lee, Naihua Duan, Ellen Rudy, Terry K. Nakazono, John Boscardin, Lisa Kakinami, Steven Shoptaw, Allison Diamant, William E. Cunningham Source Type: journals

The Impact of CHIP on Children's Insurance Coverage: An Analysis Using the National Survey of America's FamiliesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To assess the impact of the Children's Health Insurance Program (CHIP) on the distribution of health insurance coverage for low-income children. The primary data for the study were from the 1997, 1999, and 2002 National Survey of America's Families (NSAF), which includes a total sample of 62,497 children across all 3 years, supplemented with data from other data sources. The study uses quasi-experimental designs and tests the sensitivity of the results to using instrumental variable and difference-in-difference approaches. A detailed Medicaid and CHIP eligibility model was developed for this study. Balanced repeated replic...
Source: Health Services Research - September 23, 2009 Category: Health Management Authors: Lisa Dubay, Genevieve Kenney Source Type: journals

Racial and Ethnic Disparities in the Treatment of a Medicaid Population with SchizophreniaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To assess health care disparities among black and Latino adults with schizophrenia receiving services during the period July 1994[ndash]June 2006, and to evaluate trends in observed disparities. Administrative claims data from the Florida Medicaid program. Data sources included membership files (demographic information), medical claims (diagnostic, service, and expenditure information), and pharmacy claims (prescriptions used and expenditures). We identified adults with at least two schizophrenia claims during a fiscal year. We used generalized estimating equation models to estimate disparities in spending on psychotropic ...
Source: Health Services Research - September 23, 2009 Category: Health Management Authors: Marcela Horvitz-Lennon, Thomas G. McGuire, Margarita Alegria, Richard G. Frank Source Type: journals

Role and Involvement of Life End Information Forum Physicians in Euthanasia and Other End-of-Life Care Decisions in Flanders, BelgiumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To describe role and involvement of Life End Information Forum (LEIF) physicians in end-of-life care decisions and euthanasia in Flanders. All 132 LEIF physicians in Belgium received a questionnaire inquiring about their activities in the past year, and their end-of-life care training and experience. Response rate was 75 percent. Most respondents followed substantive training in end-of-life care. In 1 year, LEIF physicians were contacted 612 times for consultations in end-of-life decisions, of which 355 concerned euthanasia requests eventually resulting in 221 euthanasia cases. LEIF physicians also gave information about v...
Source: Health Services Research - September 23, 2009 Category: Health Management Authors: Yanna Van Wesemael, Joachim Cohen, Bregje D. Onwuteaka-Philipsen, Johan Bilsen, Wim Distelmans, Luc Deliens Source Type: journals

The Role of Outpatient Facilities in Explaining Variations in Risk-Adjusted Readmission Rates between HospitalsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Validate risk-adjusted readmission rates as a measure of inpatient quality of care after accounting for outpatient facilities, using premature infants as a test case. Surviving infants born between January 1, 1998 and December 12, 2001 at five Northern California Kaiser Permanente neonatal intensive care units (NICU) with 1-year follow-up at 32 outpatient facilities. Using a retrospective cohort of premature infants (N=898), Poisson's regression models determined the risk-adjusted variation in unplanned readmissions between 0[ndash]1 month, 0[ndash]3 months, 3[ndash]6 months, and 3[ndash]12 months after discharge attributa...
Source: Health Services Research - September 23, 2009 Category: Health Management Authors: Scott A. Lorch, Michael Baiocchi, Jeffrey H. Silber, Orit Even-Shoshan, Gabriel J. Escobar, Dylan S. Small Source Type: journals

Spatial Implications Associated with Using Euclidean Distance Measurements and Geographic Centroid Imputation in Health Care ResearchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To determine the effect of using Euclidean measurements and zip-code centroid geo-imputation versus more precise spatial analytical techniques in health care research. Commercially insured members from a southeastern managed care organization. Distance from admitting inpatient facility to member's home and zip-code centroid (geographic placement) was compared using Euclidean straight-line and shortest-path drive distances (measurement technique). Administrative claims from October 2005 to September 2006. Measurement technique had a greater impact on distance values compared with geographic placement. Drive distance from th...
Source: Health Services Research - September 23, 2009 Category: Health Management Authors: Stephen G. Jones, Avery J. Ashby, Soyal R. Momin, Allen Naidoo Source Type: journals

Employer Demand for Health Services Researchers in the Year 2020Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To describe factors that will shape future demand for doctoral-trained health services researchers. Commentary based on recent trends in funding for health services research (HSR), the number of federally funded HSR projects listed in HSRProj, national expenditures for health, and interviews with a small number of employers. Despite rapid growth in the overall health care sector, inflation-adjusted funding for HSR has declined, implying little or no net growth in demand for people to lead HSR studies. Employers report being able to hire researchers to conduct HSR by drawing on people trained in many disciplines. Employers ...
Source: Health Services Research - September 23, 2009 Category: Health Management Authors: Craig Thornton, Jonathan D. Brown Source Type: journals

Do Physicians Attend to Base Rates? Prevalence Data and Statistical Discrimination in the Diagnosis of Coronary Heart DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine whether physicians attend to gender prevalence data in diagnostic decision making for coronary heart disease (CHD) and to test the hypothesis that previously reported gender differences in CHD diagnostic certainty are due to discrimination arising from reliance on prevalence data ("statistical discrimination"). A vignette-based experiment of 256 randomly sampled primary care physicians conducted from 2006 to 2007. Factorial experiment. Physicians observed patient presentations of cardinal CHD symptoms, standardized across design factors (gender, race, age, socioeconomic status). Structured interview. Most physic...
Source: Health Services Research - September 22, 2009 Category: Health Management Authors: Nancy N. Maserejian, Karen E. Lutfey, John B. McKinlay Source Type: journals

The Influence of Targeted Education on Medication Persistence and Generic Substitution among Consumer-Directed Health Care EnrolleesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To evaluate an educational outreach among consumer-directed health plan (CDHP) enrollees on medication persistence and lower-cost generic substitution within four chronic medication therapies. A cross-sectional analysis using pharmacy claims data from a national employer group that began offering a CDHP in 2006 and implemented an educational outreach to some CDHP enrollees in 2007 was used. The intervention group was comprised of CDHP enrollees who received education outreach and was compared with CDHP enrollees without the educational outreach. Adjusted and unadjusted medication persistence and lower-cost generic substitu...
Source: Health Services Research - September 22, 2009 Category: Health Management Authors: Rebecca L. Sedjo, Emily R. Cox Source Type: journals

Organizational Characteristics and Cancer Care for Nursing Home ResidentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We evaluate whether organization, market, policy, and resident characteristics are related to cancer care processes and outcomes for dually eligible residents of Michigan nursing homes who entered facilities without a cancer diagnosis but subsequently developed the disease. Using data from the Michigan Tumor Registry (1997[ndash]2000), Medicare claims, Medicaid cost reports, and the Area Resource File, we estimate logistic regression models of diagnosis at or during the month of death and receipt of pain medication during the month of or month after diagnosis. Approximately 25 percent of the residents were diagnosed at or ...
Source: Health Services Research - September 22, 2009 Category: Health Management Authors: Jan P. Clement, Cathy J. Bradley, Chunchieh Lin Source Type: journals

Preparing the Health Services Research WorkforceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To describe the ways in which investigators are trained for careers in health services research and estimate their number. Sources describing health services research (HSR) training were consulted and published inventories of HSR training programs were reviewed and 124 training programs were contacted and interviewed to determine the numbers of students and the content of their HSR degree programs. Observational study. HSR programs listed by AcademyHealth were surveyed and asked for details of enrollments; course content was captured from websites for the remaining programs. There are over 300 programs that train investiga...
Source: Health Services Research - September 22, 2009 Category: Health Management Authors: Thomas C. Ricketts Source Type: journals

The Health Services Researcher of 2020: A Summit to Assess the Field's Workforce NeedsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To summarize the current state of the health services research (HSR) workforce and recommend ways to improve the field's ability to respond to future challenges facing the health system. Summaries of workgroup discussions and recommendations at a stakeholder meeting. In late 2007, 50 educators, students, employers, and funders of HSR participated in a meeting to discuss findings of three commissioned papers on the HSR workforce. The group undertook a consultative process to develop recommendations for the field. Stakeholders developed recommendations in five major areas focused on HSR workforce needs: (1) improving the siz...
Source: Health Services Research - September 22, 2009 Category: Health Management Authors: Patricia Pittman, Erin Holve Source Type: journals

The Health Services Research Workforce: Current StockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine the size and characteristics of the health services research (HSR) workforce; the job satisfaction, job security, and future plans reported by the workforce; and the future of the HSR workforce supply. (1) AcademyHealth active and lapsed members since 2000 and annual research meeting presenters and interest group participants; (2) principal investigators of research projects listed in the HSRProj database; and (3) authors of articles published in two HSR journals. Data on investigators conducting HSR in selected venues were collected and compared in order to identify the percentage of the HSR workforce represent...
Source: Health Services Research - September 22, 2009 Category: Health Management Authors: Sandra McGinnis, Jean Moore Source Type: journals

Development of a Measure of Patient Safety Event Learning ResponsesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To define patient safety event (PSE) learning response and to provide preliminary validation of a measure of PSE learning response. Ten focus groups with front-line staff and managers, an expert panel, and cross-sectional survey data from patient safety officers in 54 general acute hospitals. A mixed methods study to define a measure of learning responses to patient safety failures that is rooted in theory, expert knowledge, and organizational practice realities. Learning response items developed from the literature were modified and validated in front-line staff and manager focus groups and by an expert panel and second g...
Source: Health Services Research - September 2, 2009 Category: Health Management Authors: Liane R. Ginsburg, You-Ta Chuang, Peter G. Norton, Whitney Berta, Deborah Tregunno, Peggy Ng, Julia Richardson Source Type: journals

Mistrust of Health Care Organizations Is Associated with Underutilization of Health ServicesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We report the validation of an instrument to measure mistrust of health care organizations and examine the relationship between mistrust and health care service underutilization. We conducted a telephone survey of a random sample of households in Baltimore City, MD. We surveyed 401 persons and followed up with 327 persons (81.5 percent) 3 weeks after the baseline interview. We conducted tests of the validity and reliability of the Medical Mistrust Index (MMI) and then conducted multivariate modeling to examine the relationship between mistrust and five measures of underutilization of health services. Using principle compon...
Source: Health Services Research - September 1, 2009 Category: Health Management Authors: Thomas A. LaVeist, Lydia A. Isaac, Karen Patricia Williams Source Type: journals

Learning by Doing, Scale Effects, or Neither? Cardiac Surgeons after ResidencyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine impacts of operating surgeon scale and cumulative experience on postoperative outcomes for patients treated with coronary artery bypass grafts (CABG) by "new" surgeons. Pooled linear, fixed effects panel, and instrumented regressions were estimated. The administrative data included comorbidities, procedures, and outcomes for 19,978 adult CABG patients in Florida in 1998[ndash]2006, and public data on 57 cardiac surgeons who completed residencies after 1997. Analysis was at the patient level. Controls for risk, hospital scale and scope, and operating surgeon characteristics were made. Patient choice model instrum...
Source: Health Services Research - September 1, 2009 Category: Health Management Authors: Marco D. Huesch Source Type: journals

Impact of Family Structure on Stimulant Use among Children with Attention-Deficit/Hyperactivity DisorderEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine the impact of family structure on pharmacologic stimulant use among children with attention-deficit/hyperactivity disorder (ADHD). Nationally representative, population-based sample of the National Health Interview Survey from 1997 to 2003 linked with drug event files from the Medical Expenditure Panel Survey from 1998 to 2005. Stepwise multivariate logistic regression was used to examine the likelihood of stimulant use for each individual during 2 years of observation after adjustment for sociodemographic, health, and family characteristics. Stratified analyses were also conducted to examine whether family char...
Source: Health Services Research - September 1, 2009 Category: Health Management Authors: Atonu Rabbani, G. Caleb Alexander Source Type: journals

Variation in Emergency Department Wait Times for Children by Race/Ethnicity and Payment SourceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To quantify the variation in emergency department (ED) wait times by patient race/ethnicity and payment source, and to divide the overall association into between- and within-hospital components. 2005 and 2006 National Hospital Ambulatory Medical Care Surveys. Linear regression was used to analyze the independent associations between race/ethnicity, payment source, and ED wait times in a pooled cross-sectional design. A hybrid fixed effects specification was used to measure the between- and within-hospital components. Data were limited to children under 16 years presenting at EDs. Unadjusted and adjusted ED wait times were...
Source: Health Services Research - September 1, 2009 Category: Health Management Authors: Christine Y. Park, Mary Alice Lee, Andrew J. Epstein Source Type: journals

ForewordEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Health Services Research)
Source: Health Services Research - August 17, 2009 Category: Health Management Authors: F. Douglas Scutchfield Source Type: journals

Applying Health Services Research to Public Health Practice: An Emerging PriorityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Health Services Research)
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: F. Douglas Scutchfield, Glen P. Mays, Nicole Lurie Source Type: journals

Commentary: Partnership for the Future of Public Health Services and Systems ResearchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Health Services Research)
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: Debra Joy Pérez, Michelle Ann Larkin Source Type: journals

Public Health Emergency Preparedness at the Local Level: Results of a National SurveyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To study the relationship between elements of public health infrastructure and local public health emergency preparedness (PHEP). National Association of County and City Health Officials 2005 National Profile of Local Health Departments (LHDs). Cross-sectional. LHDs serving larger populations are more likely to have staff, capacities, and activities in place for an emergency. Adjusting for population size, the presence of a local board of health and the LHDs' experience in organizing PHEP coalitions were associated with better outcomes. The results of this study suggest that more research should be conducted to investigate...
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: Elena Savoia, Angie Mae Rodday, Michael A. Stoto Source Type: journals

Agency Discretion and Public Health Service DeliveryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To study how changes in law shape the public health system. State newborn screening laws and the National Newborn Screening and Genetics Resource Center (NNSGRC). A time-series, quasi-experimental design spanning the years 1990[ndash]2006 for all states and the District of Columbia was conducted. Analysis proceeded using a multinomial logit with a dependent variable of whether agencies lagged behind, were on target with, or led their newborn screening law. Explanatory variables of three different types of limitations on agency discretion plus relevant controls were included in the model. State laws were coded for three typ...
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: Pamela J. Clouser McCann Source Type: journals

Public Health Systems: A Social Networks PerspectiveEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine the relationship between public health system network density and organizational centrality in public health systems and public health governance, community size, and health status in three public health domains. During the fall and the winter of 2007[ndash]2008, primary data were collected on the organization and composition of eight rural public health systems. Multivariate analysis and network graphical tools are used in a case comparative design to examine public health system network density and organizational centrality in the domains of adolescent health, senior health, and preparedness. Differences assoc...
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: Douglas R. Wholey, Walter Gregg, Ira Moscovice Source Type: journals

Introducing Quality Improvement Methods into Local Public Health Departments: Structured Evaluation of a Statewide Pilot ProjectEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To test the feasibility and assess the preliminary impact of a unique statewide quality improvement (QI) training program designed for public health departments. One hundred and ninety-five public health employees/managers from 38 local health departments throughout Minnesota were selected to participate in a newly developed QI training program and 65 of those engaged in and completed eight expert-supported QI projects over a period of 10 months from June 2007 through March 2008. As part of the Minnesota Quality Improvement Initiative, a structured distance education QI training program was designed and deployed in a first...
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: William Riley, Helen Parsons, Kim McCoy, Debra Burns, Donna Anderson, Suhna Lee, François Sainfort Source Type: journals

A Framework to Measure the Value of Public Health ServicesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To develop a framework that public health practitioners could use to measure the value of public health services. Primary data were collected from August 2006 through March 2007. We interviewed (n=46) public health practitioners in four states, leaders of national public health organizations, and academic researchers. Using a semi-structured interview protocol, we conducted a series of qualitative interviews to define the component parts of value for public health services and identify methodologies used to measure value and data collected. The primary form of analysis is descriptive, synthesizing information across respon...
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: Peter D. Jacobson, Peter J. Neumann Source Type: journals

Geographic Variation in Public Health Spending: Correlates and ConsequencesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine the extent of variation in public health agency spending levels across communities and over time, and to identify institutional and community correlates of this variation. Three cross-sectional surveys of the nation's 2,900 local public health agencies conducted by the National Association of County and City Health Officials in 1993, 1997, and 2005, linked with contemporaneous information on population demographics, socioeconomic characteristics, and health resources. A longitudinal cohort design was used to analyze community-level variation and change in per-capita public health agency spending between 1993 and...
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: Glen P. Mays, Sharla A. Smith Source Type: journals

Toward Standardized, Comparable Public Health Systems Data: A Taxonomic Description of Essential Public Health WorkEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To identify taxonomy of task, knowledge, and resources for documenting the work performed in local health departments (LHDs). Secondary data were collected from documents describing public health (PH) practice produced by organizations representing the PH community. A multistep consensus-based method was used that included literature review, data extraction, expert opinion, focus group review, and pilot testing. Terms and concepts were manually extracted from documents, consolidated, and evaluated for scope and sufficiency by researchers. An expert panel determined suitability of terms and a hierarchy for classifying them....
Source: Health Services Research - August 16, 2009 Category: Health Management Authors: Jacqueline Merrill, Jonathan Keeling, Kristine Gebbie Source Type: journals

Jurisdiction Size and Local Public Health SpendingEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine if a minimum efficient scale (MES) holds with respect to the population serviced by a local health department (LHD) given the congestability, externality, and scale/scope economy effects potentially associated with public health services. A nationally representative sample of LHDs in 2005. Multiple regression analysis is used to isolate the relation between population and spending while controlling for other factors known to influence local public health costs. Data were obtained from the 2005 National Profile of Local Public Health Agencies, a project supported through a cooperative agreement between the Nation...
Source: Health Services Research - July 27, 2009 Category: Health Management Authors: Rexford E. Santerre Source Type: journals

Improving Disparity Estimates for Rare Racial/Ethnic Groups with Trend Estimation and Kalman Filtering: An Application to the National Health Interview SurveyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Single-year estimates of health disparities in small racial/ethnic groups are often insufficiently precise to guide policy, whereas estimates that are pooled over multiple years may not accurately describe current conditions. While collecting additional data is costly, innovative analytic approaches may improve the accuracy and utility of existing data. We developed an application of the Kalman filter in order to make more efficient use of extant data. We used 1997[ndash]2004 National Health Interview Survey data on the prevalence of health outcomes for two racial/ethnic subgroups: American Indians/Alaska Natives and Chine...
Source: Health Services Research - July 26, 2009 Category: Health Management Authors: Marc N. Elliott, Daniel F. McCaffrey, Brian K. Finch, David J. Klein, Nate Orr, Megan K. Beckett, Nicole Lurie Source Type: journals

Outpatient Satisfaction: The Role of Nominal versus Perceived CommunicationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To examine the simultaneous associations of parent and coder assessments of communication events with parent satisfaction. Five hundred twenty-two pediatrician[ndash]patient encounters. Parents reported on post-visit satisfaction with care and whether four communication events occurred. Raters also coded communication events from videotapes. Multivariate analyses predicted parent satisfaction. Satisfaction was greater when parents perceived at least three communication events. Parent and coder reports were nearly uncorrelated. Coder-assessed communication events not perceived by parents were unrelated to parent satisfactio...
Source: Health Services Research - July 26, 2009 Category: Health Management Authors: Megan K. Beckett, Marc N. Elliott, Andrea Richardson, Rita Mangione-Smith Source Type: journals

Hospice Characteristics and the Disenrollment of Patients with CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To characterize the types of hospices with higher rates of patient disenrollment from the Medicare Hospice Benefit and the markets in which these hospices operate. Secondary analyses of Surveillance, Epidemiology and End Results-Medicare data. Analyses included patients who died of cancer from 1998 to 2002 and who used hospice (n=90,826). We used generalized estimating equations to estimate the association of patient disenrollment with hospice size, years since Medicare certification, ownership, staff mix, competition, urban/rural status, region, and fiscal intermediary. Other covariates included patient demographic and cl...
Source: Health Services Research - July 26, 2009 Category: Health Management Authors: Melissa D. A. Carlson, Jeph Herrin, Qingling Du, Andrew J. Epstein, Emily Cherlin, R. Sean Morrison, Elizabeth H. Bradley Source Type: journals

Implications of the Growing Use of Wireless Telephones for Health Care Opinion PollsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To assess the effect of wireless telephone substitution in a survey of health care reform opinions. Survey of New Jersey adults conducted by landline and wireless telephones from June 1 to July 9, 2007. Eighty-one survey measures are compared by wireless status. Logistic regression is used to confirm landline[ndash]wireless gaps in support for coverage reforms, controlling for population differences. Weights adjust for selection probability, complex sample design, and demographic distributions. Significant differences by wireless status were found in many survey measures. Wireless users were significantly more likely to fa...
Source: Health Services Research - July 26, 2009 Category: Health Management Authors: Joel C. Cantor, Susan Brownlee, Cliff Zukin, John M. Boyle Source Type: journals