A Decomposition Method to Assess the Contributions of Geographic and Nongeographic Factors to White-Black Disparities in Health Care
Conclusions: Decomposition methods are a useful tool in quantifying the contributions of various factors to the white-black gap in high-quality hospital use and could inform local policy aimed at reducing disparities in hospital quality. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Online Article: Applied Methods Source Type: research

Evaluation of a Medicaid Lock-in Program: Increased Use of Opioid Use Disorder Treatment but No Impact on Opioid Overdose Risk: Erratum
No abstract available (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Erratum Source Type: research

Health Fairs Remain Important for Chinese Americans After Implementation of the Affordable Care Act: The Asian Pacific Health Corps Experience
No abstract available (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Letter to the Editor Source Type: research

Politics and Policymaking in Medicare Part C
Conclusions: As Medicare Advantage becomes an increasingly prominent area of focus for the health services, health policy, and medical research communities, it is important to bear in mind the highly political history of the program, the role of stakeholder influence in shaping the direction of policy, and to understand the historic barriers to evidence-based policymaking. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Annals Source Type: research

Evaluating Race and Ethnicity Reported in Hospital Discharge Data and Its Impact on the Assessment of Health Disparities
Conclusions: The quality of hospital discharge data varies by race/ethnicity and may underestimate disparities in some groups. Future research should validate findings with other data sources, identify driving factors, and evaluate progress over time. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Brief Report Source Type: research

The Prevalence and Incidence of Attention-deficit/Hyperactivity Disorder in the Veterans Health Administration From 2009 to 2016
The objective of this study was to explore trends in the prevalence, incidence, and correlates of adult ADHD in a national sample of veterans receiving care at Veteran Affairs (VA) hospitals and clinics. Research Design: A retrospective design was used to examine ADHD diagnosed in all VA primary care (PC) and mental health clinics (MHCs) from fiscal years (FYs) 2009 to 2016. Age-adjusted prevalence and incidence were calculated using direct standardization, and Poisson regressions modeled differences in trends between demographic groups. Subjects: All veterans with VA PC or MHC visits during the observation period. ...
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Weight Loss for Patients With Obesity: An Analysis of Long-Term Electronic Health Record Data
Background: Numerous studies have reported that losing as little as 5% of one’s total body weight (TBW) can improve health, but no studies have used electronic health record data to examine long-term changes in weight, particularly for adults with severe obesity [body mass index (BMI) ≥35 kg/m2]. Objective: To measure long-term weight changes and examine their predictors for adults in a large academic health care system. Research Design: Observational study. Subjects: We included 59,816 patients aged 18–70 years who had at least 2 BMI measurements 5 years apart. Patients who were underweigh...
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Understanding Geographic Variation in Systemic Overuse Among the Privately Insured
Background: Medical care overuse is a significant source of patient harm and wasteful spending. Understanding the drivers of overuse is essential to the design of effective interventions. Objective: We tested the association between structural factors of the health care delivery system and regional differences systemic overuse. Research Design: We conducted a retrospective analysis of deidentified claims for 18- to 64-year-old adults from the IBM MarketScan Commercial Claims and Encounters Database. We calculated a semiannual Johns Hopkins Overuse Index for each of the 375 Metropolitan Statistical Areas in the Unit...
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Risk of Frequent Emergency Department Use Among an Ambulatory Care Sensitive Condition Population: A Population-based Cohort Study
Conclusions: The ability to identify frequent ED users based only on previous ED and hospitalization use provides an opportunity to rapidly target this population for appropriate interventions. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

The Impact of Morphine Equivalent Daily Dose Threshold Guidelines on Prescribed Dose in a Workers’ Compensation Population
Conclusions: Passage of workers’ compensation MEDD guidelines was associated with decreases in prescribed opioid dose among injured workers. Disseminating MEDD guidelines to doctors who treat workers’ compensation cases may address an important risk factor for opioid-related mortality, while still allowing for autonomy in practice. Further research is needed to determine whether MEDD policies influence prescribing behavior and patient outcomes in other populations. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Characteristics and Operational Performance of Hospital-affiliated Freestanding Emergency Departments
Conclusions: Hospital-affiliated FREDs serve more affluent and less diverse patient populations and geographic communities. Relative to HEDs, they have lower acuity patient visits with fewer tests, and they have shorter lengths of stay, even after adjustment for patient visit characteristics. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Development and Validation of an Administrative Claims-based Measure for All-cause 30-day Risk-standardized Readmissions After Discharge From Inpatient Psychiatric Facilities
Conclusions: The measure provides an assessment of facility-level quality and insight into risk factors useful for informing preventive interventions. The measure will be included in the Centers for Medicare and Medicaid Services (CMS) Inpatient Psychiatric Quality Reporting program in 2019. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Depression and Uptake of Oral Anticoagulation Therapy in Patients With Atrial Fibrillation: A Danish Nationwide Cohort Study
Conclusions: Comorbid depression was associated with a significantly lower OAT uptake in patients with AF, which questions whether depressed patients receive sufficient support to manage this consequential cardiac condition. However, a substantial increase in the overall OAT uptake and a decrease of the depression-associated deficit in OAT were seen over the period during which OAT was developed through the introduction of new oral anticoagulation therapy. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Drivers of High-cost Medical Complexity in a Medicaid Population
Conclusion: Clinical and policy strategies that mitigate high-impact social drivers of poor outcomes are likely critical for improving both health and costs for complex, high-needs patients. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Original Articles Source Type: research

Continuity of Care and Mental Health Service Use Among Medicaid-enrolled Youths
Conclusions: The odds of potentially disruptive clinical management and costly psychiatric ED visits or hospitalizations were lower for youths with high CoC. The findings support the need to research the impact of CoC on long-term pediatric mental health service use. (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Award Winning Manuscripts from APHA 2018 Source Type: research

Characteristics of Trials Associated With Drugs Approved by the Food and Drug Administration in 2015 and 2016
Introduction: New drug products are tested for safety and efficacy in clinical trials before being approved for use in medical practice. Clinical trial data are often misreported or underreported to ClinicalTrials.gov and in the medical literature. There is limited research on clinical trial characteristics for Food and Drug Administration (FDA) approved drugs, particularly examining differences in characteristics across different approval pathways or therapeutic indications. Methods: Data from the Aggregate Analysis of ClinicalTrials.gov (AACT) were used to compare the characteristics of completed clinical trials for...
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Award Winning Manuscripts from APHA 2018 Source Type: research

2018 American Public Health Association’s Medical Care Section Student Awardees
No abstract available (Source: Medical Care)
Source: Medical Care - February 13, 2020 Category: Health Management Tags: Commentary Source Type: research

A Pharmaceutical Dispensing–based Index of Mortality Risk From Long-term Conditions Performed as well as Hospital Record–based Indices
Conclusions: The P3 index provides an appropriate alternative to measures like the Charlson and M3 index when analysts only have access to pharmaceutical dispensing data for determining multimorbidity. The P3 index had a performance advantage over Charlson when analyzing risk for overnight hospital admissions. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Online Article: Applied Methods Source Type: research

Provider Perspectives When Integrating Social Determinants of Health in Response to Schickedanz A, Hamity C, Rogers A, et al, Clinician Experiences and Attitudes Regarding Screening for Social Determinants of Health in a Large Integrated Health System
No abstract available (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Letter to the Editor Source Type: research

The Impact of Massachusetts Health Reform on Colorectal and Breast Cancer Stage at Diagnosis
Conclusions: The decline in the likelihood of advanced stage CRC diagnosis after Massachusetts health reform may suggest improvements in access to health care and CRC screening. Similar declines were not observed for BCA, perhaps due to established BCA-specific safety-net programs. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-stay Nursing Home Residents
Background: Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited. Objectives: To construct and validate 3 quarterly risk-adjusted rates of long-stay residents’ ED use: any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED). Research Design: The authors calculated quarterly NH risk-adjusted ED rates from 2011 Q2 to 2013 Q3 national Medicare claims and Minimum Data Set data. Using random-effect linear regressions, the authors val...
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Evaluating the Role of Past Clinical Information on Risk Adjustment
Conclusion: Incorporating historical clinical information yielded no material gain in risk adjustment fit. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Brief Report Source Type: research

Opportunity or Burden? A Behavioral Framework for Patient Engagement
Conclusions: This framework can be applied to judgments regarding a patient’s propensity to engage in care. Because self-efficacy is an individual’s context-specific judgment of their capabilities, this framework may inform health care and social service interventions that aim to engage patients. This maybe especially useful for public sector settings and populations with social risks. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Patient-centered Care Source Type: research

Provider Practice Competition and Adoption of Medicare’s Oncology Care Model
Conclusions: OCM adoption was higher in HRRs with greater competition. Careful monitoring of market-level changes among OCM adopters should be undertaken to ensure that the benefits of the OCM outweigh the negative consequences of possible changes in competition. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

A Comparison of Health Risk and Costs Across Private Insurance Markets
Conclusions: On average, the PPACA individual market enrolls sicker individuals than the 2 group markets. But this does not translate to higher health costs; in fact, enrollees in the PPACA individual market accumulate lower allowed charges than enrollees in the large employer market. Lower-income enrollees particularly accumulate lower allowed charges. Narrower networks and increased enrollee cost-sharing among individual market plans, though they may reduce the value of coverage, likely significantly reduce allowed charges. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States
Conclusions: Health policy interventions to reduce duplicative or unnecessary ED use should apply a population health perspective and engage multiple hospitals. Community-level preventive approaches and a stronger infrastructure for mental health and substance use are essential to mitigate multisite ED use. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Effects of Cardiovascular Health Shocks on Spouses’ Work and Earnings: A National Study
Conclusion: Beyond assessing average values, detailed analysis of changes in spousal earnings after common cardiovascular health shocks did not demonstrate effects attributable to those health shocks. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Higher Rates of Preventive Health Care With Commercial Insurance Compared With Medicaid: Findings From the Arkansas Health Care Independence “Private Option” Program
Conclusions: These findings suggest that at least for preventive services, the Medicaid federal equal access requirement is not being met for those within Medicaid fee-for-service coverage. This persisted across all 3 years of the program. Differential payment rates for services between Medicaid and QHPs are likely a major contributing factor. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Predicting the Cost of Health Care Services: A Comparison of Case-mix Systems and Comorbidity Indices That Use Administrative Data
Conclusions: All these systems have empirical support for use in predicting health care costs, despite in some cases being developed for other purposes. No system is particularly effective at predicting next-year acute care cost, likely because acute events are often by definition unexpected. The freely available ECI and CCI comorbidity indices implemented using the highest-performing methods developed here may be a good choice in many circumstances. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Evaluation and Treatment Patterns of New Low Back Pain Episodes for Elderly Adults in the United States, 2011–2014
Conclusions: Many patients who develop new LBP receive guideline nonconcordant care such as early advanced imaging and opioids before other modalities like PT and prescription NSAIDs. (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Changes in Medicaid Acceptance by Substance Abuse Treatment Facilities After Implementation of Federal Parity
Background: Adequate access for mental illness and substance use disorder (SUD) treatment, particularly for Medicaid enrollees, is challenging. Policy efforts, including the Mental Health Parity and Addiction Equity Act (MHPAEA), have targeted expanded access to care. With MHPAEA, more Medicaid plans were required to increase their coverage of SUD treatment, which may impact provider acceptance of Medicaid. Objectives: To identify changes in Medicaid acceptance by SUD treatment facilities after the implementation of MHPAEA (parity). Research Design: Observational study using an interrupted time series design. Subj...
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Original Articles Source Type: research

Beyond Parity: Medicaid Policy and Improving Access to Effective Substance Use Disorder Treatment
No abstract available (Source: Medical Care)
Source: Medical Care - January 15, 2020 Category: Health Management Tags: Commentary Source Type: research

Validity of Race and Ethnicity Codes in Medicare Administrative Data Compared With Gold-standard Self-reported Race Collected During Routine Home Health Care Visits
Discussion: The status quo of using “good-enough for government” race/ethnicity variables contained in Medicare administrative data for minority health disparities research can be improved through the use of self-reported race/ethnicity data, available in the Medicare data warehouse. Health services and policy researchers should critically examine the source of race/ethnicity variables used in minority health and health disparities research. Future work to improve the accuracy of Medicare beneficiaries’ race/ethnicity data should incorporate and augment the self-reported race/ethnicity data contained in...
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Online Article: Applied Methods Source Type: research

The Impact of a National Health Information Exchange Program Under a Single-payer System
Conclusions: The health information exchange program has reduced medication duplication, yet the reduction was not entirely associated with record inquiries. The hospitals have responded to the challenge of medication duplication by enhancing internal prescription control via a prescription alert system, which may have contributed to the reduction in duplicate medications and is a positive, unintended consequence of the intervention. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Translating Data From an Electronic Prescribing and Medicines Administration System Into Knowledge: Application to Doctor-Nurse Time Discrepancy in Antibiotic Ordering and Administration
The objective of this study was to use routinely collected EPMA data in the study of exact time discrepancy between physicians’ order and nurses’ administration of systemic antibiotics. We evaluated first and follow-up dose administration and dose intervals and examined multifactorial determinants in ordering and administration explaining potential discrepancy. Methods: We conducted an observational study of electronic health records for all medical patient stays with antibiotic treatment from January to June 2018 (n=4392) in a large Belgian tertiary care hospital. Using an EPMA system with Barcode Medicatio...
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Hospitalizations Involving an Intensive Care Unit Admission Among Patients Aged 65 Years and Older Within New York City Hospitals During 2000–2014
Conclusions: This investigation provides a clearer understanding of ICU utilization among patients aged 65 years and older in NYC. Ongoing monitoring is warranted given projections that the proportion of New Yorkers aged 65 years and older will increase in coming years. In particular, in light of the observed increase of infectious principal diagnoses during the study period, further investigation is needed into the role of infectious disease in causing critical illness in NYC. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Brief Reports Source Type: research

Hospital Response to CMS Public Reports of Hospital Charge Information
Conclusion: Public reports of hospital inpatient charges by DRG appear to influence subsequent charges, slowing their growth. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Brief Reports Source Type: research

The Weekend Effect in Older Adult Urosepsis Admissions
Conclusions: Our findings suggest that weekend admission was associated with an increase in the odds of mortality in older adults with community-acquired urosepsis. Small increases in nurse staffing seem to reduce the odds of mortality. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Brief Reports Source Type: research

Report of Health Behavior Modification Among Latinos Diagnosed With Multiple Cardiovascular Risk Factors
Conclusions: Our findings provide new evidence on patterns of behavioral modification in a population-based sample of Latinos diagnosed with chronic health conditions. Findings suggest the need to promote language and culturally relevant initiatives to increase the adoption of health-enhancing behaviors and improve chronic disease management among Spanish-speaking Latinos. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Validating the New Primary Care Measure in the Medical Expenditure Panel Survey
The objective of this study was to assess the validity of a newly developed measure of primary care processes [Medical Expenditure Panel Survey (MEPS)-PC] with preliminary evidence of moderate to excellent reliability. Study Design: A retrospective cohort study of community-dwelling adults with history of office-based provider visit/s using the MEPS (2013–2014). Methods: The 3 MEPS-PC subscales (Relationship, Comprehensiveness, and Health Promotion) were tested for construct validity against known measures of primary care: Usual Source of Care, Known Provider, and Family-Usual Source of Care. Concurrent and pre...
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Association of Primary Language and Hospitalization for Ambulatory Care Sensitive Conditions
Conclusions: These findings suggest non–English-speaking patients may seek ED care for lower acuity ACSCs than English-speaking patients. Efforts to decrease preventable ED and increase access to ambulatory care use should consider the needs of non–English-speaking patients. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Adverse Events Among Hospitalized Critically Ill Patients: A Retrospective Cohort Study
The objective of this study was to estimate the frequency and type of adverse events (AEs) among critically ill patients and identify patient and hospital factors associated with AEs and clinical and health care utilization consequences of AEs. Materials and Methods: This retrospective cohort study includes patients admitted to 30 intensive care units (ICUs) in Alberta, Canada from May 2014 to April 2017. The main outcome was AEs derived from validated ICD-10, Canadian code algorithms for 18 AEs. Estimates of the proportion and rate of AEs are presented. The association between documented AEs and patient (eg, age, sex, ...
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Administrative Churn in SNAP and Health Care Utilization Patterns
Conclusions: SNAP administrative churn was very common among our study sample. Given that health care utilization patterns varied for churners compared with nonchurners, it is important that researchers and public health professionals not assume stable SNAP receipt among participants. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Brief Report Source Type: research

Thirty-Day Hospital Readmission Among Homeless Individuals With Medicaid in Massachusetts
Conclusions: To break the readmission cycle, health care providers serving homeless individuals could focus on assuring access to medical respite care and extending outreach efforts that increase primary care engagement. This may be especially important for accountable care systems, as safety net providers increasingly assume financial risk for patients’ total cost and quality of care. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Evidence of the Linkage Between Hospital-based Care Coordination Strategies and Hospital Overall (Star) Ratings
Conclusions: Care coordination strategies are associated with high overall hospital ratings. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Articles Source Type: research

Patient Characteristics Affect Discharge Status for Opioid-related Infective Endocarditis
Conclusions: The fact that patient disposition varied across different payors suggests that hospitals are missing opportunities to engage the most vulnerable patients with IE. Given the long-term care required by this condition, hospitals are well-positioned to participate in interventions to initiate substance abuse treatment and help patients navigate outpatient substance abuse treatment options. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Brief Report Source Type: research

Response to Propoxyphene Market Withdrawal: Analgesic Substitutes, Doses, and Adverse Events
Conclusions: After propoxyphene market withdrawal, many individuals experienced abrupt discontinuation of opioids. Policymakers might consider supporting appropriate treatment transitions and monitoring responses following drug withdrawals. (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Original Article Source Type: research

The Smoking Gun: Can We Do for Gun Control What We Are Doing to Control the Vaping and E-Cigarettes Epidemic?
No abstract available (Source: Medical Care)
Source: Medical Care - December 12, 2019 Category: Health Management Tags: Special Commentary Source Type: research

Using Ancillary Sociodemographic Data to Identify Sexual Minority Adults Among Those Responding “Something Else” or “Don’t Know” to Sexual Orientation Questions
Conclusions: Predicted probabilities of sexual minority orientation may be used in this and other surveys to improve representation and categorization of those who identify as a sexual minority adult. (Source: Medical Care)
Source: Medical Care - November 14, 2019 Category: Health Management Tags: Online Articles: Applied Methods Source Type: research

Differences in Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey Scores by Recency of the Last Visit: Implications for Comparability of Periodic and Continuous Sampling
Conclusions: Patients with more frequent visits reported markedly higher CG-CAHPS scores, but this causes only small to moderate changes in adjusted physician-level scores between 12-month periodic and continuous sampling schemes. Caution should be exercised in trending or comparing scores collected through different schemes. (Source: Medical Care)
Source: Medical Care - November 14, 2019 Category: Health Management Tags: Online Articles: Applied Methods Source Type: research