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Safety and Risk Management Interventions in Hospitals: A Systematic Review of the LiteratureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 t...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Duckers, M., Faber, M., Cruijsberg, J., Grol, R., Schoonhoven, L., Wensing, M. Tags: Articles Source Type: journals

The Impact of Nonphysician Clinicians: Do They Improve the Quality and Cost-Effectiveness of Health Care Services?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Laurant, M., Harmsen, M., Wollersheim, H., Grol, R., Faber, M., Sibbald, B. Tags: Articles Source Type: journals

Review Article: Effectiveness of Patient Care Teams and the Role of Clinical Expertise and Coordination: A Literature ReviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 reso...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Bosch, M., Faber, M. J., Cruijsberg, J., Voerman, G. E., Leatherman, S., Grol, R. P. T. M., Hulscher, M., Wensing, M. Tags: Articles Source Type: journals

ForewordEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Care Research and Review)
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Christianson, J. B. Tags: Articles Source Type: journals

CEO Compensation and Hospital Financial PerformanceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 i...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Reiter, K. L., Sandoval, G. A., Brown, A. D., Pink, G. H. Tags: Articles Source Type: journals

Group Health Cooperative's Transformation Toward Patient-Centered AccessEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 a...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Ralston, J. D., Martin, D. P., Anderson, M. L., Fishman, P. A., Conrad, D. A., Larson, E. B., Grembowski, D. Tags: Articles Source Type: journals

Determinants of Hospitalist Efficiency: A Qualitative and Quantitative StudyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Dynan, L., Stein, R., David, G., Kenny, L. C., Eckman, M., Short, A. D. Tags: Articles Source Type: journals

Physician Clinical Information Technology and Health Care DisparitiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 physicia...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Ketcham, J. D., Lutfey, K. E., Gerstenberger, E., Link, C. L., McKinlay, J. B. Tags: Articles Source Type: journals

The Cost-Effectiveness of Direct-to-Consumer Advertising for Prescription DrugsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 respons...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Atherly, A., Rubin, P. H. Tags: Articles Source Type: journals

Review: Use of Electronic Medical Records for Health Outcomes Research: A Literature ReviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 commo...
Source: Medical Care Research and Review - October 30, 2009 Category: Health Management Authors: Dean, B. B., Lam, J., Natoli, J. L., Butler, Q., Aguilar, D., Nordyke, R. J. Tags: Articles Source Type: journals

Understanding the Safety Net: Inpatient Quality of Care Varies Based on How One Defines Safety-Net HospitalsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 outcom...
Source: Medical Care Research and Review - September 7, 2009 Category: Health Management Authors: McHugh, M., Kang, R., Hasnain-Wynia, R. Tags: Article Source Type: journals

Segregation and Disparities in Health Services UseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 dispa...
Source: Medical Care Research and Review - September 7, 2009 Category: Health Management Authors: Gaskin, D. J., Price, A., Brandon, D. T., LaVeist, T. A. Tags: Article Source Type: journals

Understanding Observed and Unobserved Health Care Access and Utilization Disparities Among U.S. Latino AdultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Lati...
Source: Medical Care Research and Review - September 7, 2009 Category: Health Management Authors: Vargas Bustamante, A., Fang, H., Rizzo, J. A., Ortega, A. N. Tags: Article Source Type: journals

Influence of NCI Cancer Center Attendance on Mortality in Lung, Breast, Colorectal, and Prostate Cancer PatientsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Car...
Source: Medical Care Research and Review - September 7, 2009 Category: Health Management Authors: Onega, T., Duell, E. J., Shi, X., Demidenko, E., Gottlieb, D., Goodman, D. C. Tags: Article Source Type: journals

Stigma and Help Seeking for Mental Health Among College StudentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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, m...
Source: Medical Care Research and Review - September 7, 2009 Category: Health Management Authors: Eisenberg, D., Downs, M. F., Golberstein, E., Zivin, K. Tags: Article Source Type: journals

Review: Disparities in Long-Term Care: Building Equity Into Market-Based ReformsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 tha...
Source: Medical Care Research and Review - September 7, 2009 Category: Health Management Authors: Konetzka, R. T., Werner, R. M. Tags: Article Source Type: journals

Importing Medicine: A Look at Citizenship and Immigration Status for Graduating Residents in New York State From 1998 to 2007Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Car...
Source: Medical Care Research and Review - July 7, 2009 Category: Health Management Authors: Richards, M. R., Chou, C.-F., Lo Sasso, A. T. Tags: Article Source Type: journals

Medical and Dental Care Utilization and Expenditures Under Medicaid and Private Health InsuranceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 differenc...
Source: Medical Care Research and Review - July 7, 2009 Category: Health Management Authors: Ku, L. Tags: Article Source Type: journals

Cultural Competency, Race, and Skin Tone Bias Among Pharmacy, Nursing, and Medical Students: Implications for Addressing Health DisparitiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Medical Care Research and Review - July 7, 2009 Category: Health Management Authors: White-Means, S., Zhiyong Dong, , Hufstader, M., Brown, L. T. Tags: Article Source Type: journals

Racial Differences in the Impact of Comorbidities on Survival Among Elderly Men With Prostate CancerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Medical Care Research and Review - July 7, 2009 Category: Health Management Authors: Putt, M., Long, J. A., Montagnet, C., Silber, J. H., Chang, V. W., Kaijun Liao, , Schwartz, J. S., Pollack, C. E., Wong, Y.-N., Armstrong, K. Tags: Article Source Type: journals

Review: Immigrants and Health Care Access, Quality, and CostEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. Immigra...
Source: Medical Care Research and Review - July 7, 2009 Category: Health Management Authors: Pitkin Derose, K., Bahney, B. W., Lurie, N., Escarce, J. J. Tags: Article Source Type: journals

Controlling the Escalating Use of Advanced Imaging: The Role of Radiology Benefit Management ProgramsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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. (Sou...
Source: Medical Care Research and Review - May 1, 2009 Category: Health Management Authors: Mitchell, J. M., LaGalia, R. R. Tags: Article Source Type: journals

Relationship of Hospital Organizational Culture to Patient Safety Climate in the Veterans Health AdministrationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Medical Care Research and Review - May 1, 2009 Category: Health Management Authors: Hartmann, C. W., Meterko, M., Rosen, A. K., Shibei Zhao, , Shokeen, P., Singer, S., Gaba, D. M. Tags: Article Source Type: journals

Single Specialty Hospitals and Nurse Staffing PatternsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Medical Care Research and Review - May 1, 2009 Category: Health Management Authors: Carey, K., Burgess, J. F., Young, G. J. Tags: Article Source Type: journals

Social Capital and Health Care Access: A Systematic ReviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Medical Care Research and Review - May 1, 2009 Category: Health Management Authors: Pitkin Derose, K., Varda, D. M. Tags: Article Source Type: journals

Review: What Can We Learn From Quality Improvement Research?: A Critical Review of Research MethodsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 indica...
Source: Medical Care Research and Review - May 1, 2009 Category: Health Management Authors: Alexander, J. A., Hearld, L. R. Tags: Article Source Type: journals

ErratumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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)
Source: Medical Care Research and Review - April 24, 2009 Category: Health Management Tags: Article Source Type: journals

Engagement of Health Plans and Employers in Addressing Racial and Ethnic Disparities in Health CareEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 o...
Source: Medical Care Research and Review - March 4, 2009 Category: Health Management Authors: Rosenthal, M. B., Landon, B. E., Normand, S.-L. T., Ahmad, T. S., Epstein, A. M. Tags: Article Source Type: journals

Assessing Changes in High-Volume Hospital Use: Hospitals, Payers, and Aggregate Volume TrendsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 tim...
Source: Medical Care Research and Review - March 4, 2009 Category: Health Management Authors: Kronebusch, K. Tags: Article Source Type: journals

Changes in the Monitoring and Oversight Practices of Not-for-Profit Hospital Governing Boards 1989-2005: Evidence From Three National SurveysEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Medical Care Research and Review - March 4, 2009 Category: Health Management Authors: Alexander, J. A., Lee, S.-Y. D., Wang, V., Margolin, F. S. Tags: Article Source Type: journals

Measuring Adequacy of Coverage for the Privately Insured: New State Estimates to Monitor Trends in Health Insurance CoverageEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 Populati...
Source: Medical Care Research and Review - March 4, 2009 Category: Health Management Authors: Blewett, L. A., Rodin, H., Davidson, G., Davern, M. Tags: Article Source Type: journals

Improving Methods for Measuring Quality of Care: A Patient-Centered Approach in Chronic DiseaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 literatur...
Source: Medical Care Research and Review - March 4, 2009 Category: Health Management Authors: Bokhour, B. G., Pugh, M. J., Rao, J. K., Avetisyan, R., Berlowitz, D. R., Kazis, L. E. Tags: Article Source Type: journals

Review: Review of Nurse Home Visiting Interventions for Community-Dwelling Older Persons With Existing DisabilityEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 disabil...
Source: Medical Care Research and Review - March 4, 2009 Category: Health Management Authors: Liebel, D. V., Friedman, B., Watson, N. M., Powers, B. A. Tags: Article Source Type: journals

Navigating Poorly Charted Territory: Patient Dilemmas in Health Care "Nonsystems"Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 a...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Sofaer, S. Tags: Article Source Type: journals

A Perspective on the Patient's Role in Treatment DecisionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 intervent...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Sepucha, K., Mulley, A. G. Tags: Article Source Type: journals

Quality and Consumer Decision Making in the Market for Health Insurance and Health Care ServicesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Kolstad, J. T., Chernew, M. E. Tags: Article Source Type: journals

Using Systematic Measurement to Target Consumer Activation StrategiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Hibbard, J. H. Tags: Article Source Type: journals

Realizing True Consumer-Directed Health Care: What the Policy Community NeedsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Care Research and Review)
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Arnold, S. B., Scanlon, D. P. Tags: Article Source Type: journals

Who Thinks That Part D Is Too Complicated?: Survey Results on the Medicare Prescription Drug BenefitEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 multivariat...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Cummings, J. R., Rice, T., Hanoch, Y. Tags: Article Source Type: journals

The Relationship Between Super Users' Attitudes and Employee Experiences With Clinical Information SystemsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 ab...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Halbesleben, J. R. B., Wakefield, D. S., Ward, M. M., Brokel, J., Crandall, D. Tags: Article Source Type: journals

Motivating Public Use of Physician-Level Performance Data: An Experiment on the Effects of Message and ModeEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 <...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Ranganathan, M., Hibbard, J., Rodday, A. M. C., de Brantes, F., Conroy, K., Rogers, W. H., Gelb Safran, D. Tags: Article Source Type: journals

Partial-Year Insurance Coverage and the Health Care Utilization of ChildrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Leininger, L. J. Tags: Article Source Type: journals

Measuring Trends in Racial/ Ethnic Health Care DisparitiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 o...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: Le Cook, B., McGuire, T. G., Zuvekas, S. H. Tags: Article Source Type: journals

Cost of Liver Transplantation: A Systematic Review and Meta-Analysis Comparing the United States With Other OECD CountriesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 me...
Source: Medical Care Research and Review - December 30, 2008 Category: Health Management Authors: van der Hilst, C. S., IJtsma, A. J. C., Slooff, M. J. H., TenVergert, E. M. Tags: Article Source Type: journals

Effectiveness of Decision Aids: A Review of the EvidenceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 som...
Source: Medical Care Research and Review - November 17, 2008 Category: Health Management Authors: Leatherman, S., Warrick, L. Tags: Article Source Type: journals

Impact of Targeted Financial Incentives on Personal Health Behavior: A Review of the LiteratureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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 num...
Source: Medical Care Research and Review - November 17, 2008 Category: Health Management Authors: Sutherland, K., Christianson, J. B., Leatherman, S. Tags: Article Source Type: journals

Lessons From Evaluations of Purchaser Pay-for-Performance Programs: A Review of the EvidenceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
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...
Source: Medical Care Research and Review - November 17, 2008 Category: Health Management Authors: Christianson, J. B., Leatherman, S., Sutherland, K. Tags: Article Source Type: journals

ForewordEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Care Research and Review)
Source: Medical Care Research and Review - November 17, 2008 Category: Health Management Authors: Hurley, R. E. Tags: Article Source Type: journals

ErratumEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Care Research and Review)
Source: Medical Care Research and Review - November 17, 2008 Category: Health Management Tags: Article Source Type: journals

ReviewersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Medical Care Research and Review)
Source: Medical Care Research and Review - November 17, 2008 Category: Health Management Tags: Article Source Type: journals