Indirect Estimation of Race/Ethnicity for Survey Respondents Who Do Not Report Race/Ethnicity
Conclusions: It may be worthwhile to impute race/ethnicity when this information is unavailable in survey data sets due to item nonresponse, especially when missingness is high. (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Online Article: Applied Methods Source Type: research

Clinical Scenarios for Which Spinal Mobilization and Manipulation Are Considered by an Expert Panel to be Inappropriate (and Appropriate) for Patients With Chronic Low Back Pain
Conclusions: A well-validated expert panel-based approach was used to develop and then rate the appropriateness of the use of spinal mobilization and manipulation across the clinical scenarios which could present for CLBP. Information on the clinical scenarios for which these therapies are inappropriate should be added to clinical guidelines for CLBP. (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Factors Associated With Accuracy of Self-Assessment Compared With Tested Non–English Language Proficiency Among Primary Care Providers
Background: There are no accepted best practices for clinicians to report their non–English language (NEL) fluencies. Language discordance between patients with limited English proficiency and their clinicians may contribute to suboptimal quality of care. Objectives: To compare self-assessed clinician NEL proficiency with a validated oral language proficiency test. To identify clinician characteristics associated with self-assessment accuracy. Subjects: Primary care providers from California and Massachusetts. Research Design: We surveyed 98 clinicians about demographics and their NEL self-assessment using...
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Retooling of Paper-based Outcome Measures to Electronic Format: Comparison of the NY State Public Risk Model and EHR-derived Risk Models for CABG Mortality
Background: Risk adjustment is critical in the comparison of quality of care and health care outcomes for providers. Electronic health records (EHRs) have the potential to eliminate the need for costly and time-consuming manual data abstraction of patient outcomes and risk factors necessary for risk adjustment. Methods: Leading EHR vendors and hospital focus groups were asked to review risk factors in the New York State (NYS) coronary artery bypass graft (CABG) surgery statistical models for mortality and readmission and assess feasibility of EHR data capture. Risk models based only on registry data elements that can ...
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Changes in Caregiver Health in the Years Surrounding the Birth of a Child With Health Problems: Administrative Data From British Columbia
Conclusions: Health issues associated with having a child with a health problem may begin well before the birth of the child, but also appear to be exacerbated postbirth. The health challenges of caregivers of CHPs may be multifactorial, involving both preexisting conditions and the stresses associated with caring for a child with health problems. (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

The Association of Nurse Practitioner Scope-of-Practice Laws With Emergency Department Use: Evidence From Medicaid Expansion
Conclusions: Allowing NPs to practice without physician oversight was associated with a reduction in the magnitude of increase in ED use following Medicaid expansion. States that restrict NP practice should weigh the costs of maintaining these restrictions against the potential benefits of lower ED use. States considering Medicaid expansion should also consider relaxing NP scope-of-practice laws. (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

A Meta-Analysis of the Associations Between the Nurse Work Environment in Hospitals and 4 Sets of Outcomes
Conclusions: The nurse work environment warrants attention to promote health care quality, safety, and patient and clinician well-being. (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Does Primary Care Provider Supply Influence Medicaid Acceptability?
In this study, we determine whether physician’s willingness to accept new Medicaid patients is moderated by the availability of other providers in close proximity. Methods: The study uses Michigan simulated patient (ie, “secret shopper”) data collected during 2014 and 2015, and applies a difference-in-differences styled event-study regression approach comparing trends in Medicaid acceptability and appointment scheduling between areas in Michigan with higher densities of primary care providers against those with lower densities of providers that could arguably be classified a health professional shortag...
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Brief Report Source Type: research

Relationship Between State Policy and Anesthesia Provider Supply in Rural Communities
Conclusions: State regulations may lead to increased supply of CRNAs in rural communities. However, the design of our study makes causality difficult to assert. So, it is also possible that states set CRNA policy as a response to counts of anesthesia providers in rural areas. Furthermore, given supply of anesthesiologists and CRNAs are complementary to one another, improving access to anesthesia services may require addressing issues pertaining to the supply of all anesthesia provider types. (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

US Physicians’ Work Motivation and Their Occupational Health: A National Survey of Practicing Physicians
This study was a national survey of practicing physicians. A split-sample method was used to validate a measure of work motivation adapted for physicians. Subjects: In total, 3589 physicians were selected from the American Medical Association Physician Masterfile among whom 2247 physicians completed a survey (response rate of 62.6%). Measures: Eight-item measure adapted from the Work Extrinsic and Intrinsic Motivation Scale. Grounded in self-determination theory, this measure includes 2 superordinate subscales of autonomous and controlled work motivation (characterized by feeling free and volitional versus pressured ...
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Collaboration in Health Care and Social Service Networks for Older Adults: Association With Health Care Utilization Measures
We examined how characteristics of collaborative networks were associated with performance. Results: High-performing networks were distinguished from low-performing networks by 2 features: (1) health care organizations occupied positions of significantly greater centrality (P (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Collaborative Networks of Health Systems and Social Service Agencies: Clinical Public Health in Action
No abstract available (Source: Medical Care)
Source: Medical Care - April 16, 2019 Category: Health Management Tags: Editorial Source Type: research

Variation in Laboratory Test Naming Conventions in EHRs Within and Between Hospitals: A Nationwide Longitudinal Study
Conclusions: The use of electronic health record data for research requires assessing data consistency and quality. Using laboratory test results requires the use of both unstructured text fields and the identification of appropriate LOINCs. When using data from multiple facilities, the results should be carefully examined by facility and over time to maximize the capture of data fields. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Online Article: Applied Methods Source Type: research

Epilepsy Among Elderly Medicare Beneficiaries: A Validated Approach to Identify Prevalent and Incident Epilepsy
Conclusions: Prediction models using longitudinal Medicare data perform well in predicting incident and prevalent epilepsy status accurately. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Article Source Type: research

Trends in Hospital Utilization After Medicaid Expansion
Conclusions: Medicaid expansion was associated with a shift in payers among nonelderly hospitalized adults without significant changes in case-mix or in several markers of acuity. These findings suggest that Medicaid expansion may reduce uncompensated care without shifting admissions practices or acuity among hospitalized adults. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Brief Report Source Type: research

Physician Participation in Medicare Accountable Care Organizations and Spillovers in Commercial Spending
Conclusions and Relevance: Physicians who participated in Medicare ACOs did not reduce spending among most of their commercially insured patients. Medicare policy is unlikely to confer significant spillover benefits to the commercially insured population. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Article Source Type: research

ACO Affiliated Hospitals Increase Implementation of Care Coordination Strategies
Conclusion: Our findings suggest ACO affiliation and multiple payment model types are associated with the increased use of care coordination strategies. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Brief Report Source Type: research

The Impact of Pharmacy-specific Predictors on the Performance of 30-Day Readmission Risk Prediction Models
Conclusions: Adding the aggregate pharmacy score to the reference model significantly increased the c statistic but was out-performed by the comorbidity burden score model in predicting readmission. The need for a universal prioritization tool for pharmacists may therefore be potentially met with the comorbidity burden score model. However, the aggregate pharmacy score and drug class models still out-performed current Medicare readmission risk adjustment models. Implications for Policy or Practice: Pharmacists have a great role in preventing readmission, and therefore can potentially use one of our models: comorbidity...
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Articles Source Type: research

Comparison of Medicare Claims-based Proxy Measures of Poor Function and Associations With Treatment Receipt and Mortality in Older Colon Cancer Patients
Conclusions: While agreement varied across the claims-based proxy measures, each demonstrated anticipated associations with treatment receipt and mortality independent of comorbidity. Claims-based comparative effectiveness studies in older populations should consider applying one of these models to improve confounding control. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Articles Source Type: research

Regional and Rural-Urban Differences in the Use of Direct-acting Antiviral Agents for Hepatitis C Virus: The Veteran Birth Cohort
Background: Veterans with hepatitis C virus (HCV) infection may face geographic obstacles to obtaining treatment. Objective: We studied the influence of region and rural versus urban residence on receipt of direct-acting antiretroviral (DAA) medications for HCV. Subjects: Veterans receiving care within Veterans Affairs Healthcare System born between 1945 and 1965. Research Design: This is a observational study using national electronic health record data. Measures: Receipt of DAAs was defined as ≥1 filled prescription from January 1, 2014 to December 31, 2016. Region (South, Northeast, Midwest, and West) a...
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Brief Report Source Type: research

Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration’s Homeless Patient Aligned Care Teams
Conclusions: Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, when compared with standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other health care settings. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Articles Source Type: research

Trends and Racial Differences in First Hospitalization for Stroke and 30-Day Mortality in the US Medicare Population From 1988 to 2013
Purpose: The main purpose of this study was to determine whether there were temporal differences in the rates of first stroke hospitalizations and 30-day mortality after stroke between black and white Medicare enrollees. Methods: We used a 20% sample of Medicare beneficiaries aged 65 years or older and described the annual rate of first hospitalization for ischemic and hemorrhagic strokes from years 1988 to 2013, as well as 30-day mortality after stroke hospitalization. We used linear tests of trend to determine whether stroke rates changed over time, and tested the interaction term between race and year to determine ...
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Articles Source Type: research

Racial Differences in Insurance Stability After Health Insurance Reform
Conclusions: Massachusetts Insurance Reform resulted in stable insurance coverage and a reduction in disparities in insurance instability by race and ethnicity. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Articles Source Type: research

Association of Federal Mental Health Parity Legislation With Health Care Use and Spending Among High Utilizers of Services
Conclusions: In 24 states, commercially insured high utilizers of mental health services experienced modest increases in outpatient mental health visits 2 years postparity. (Source: Medical Care)
Source: Medical Care - March 21, 2019 Category: Health Management Tags: Original Articles Source Type: research

A New Data Resource to Examine Meals on Wheels Clients’ Health Care Utilization and Costs
Conclusions: Linking MOW data to Medicare claims has the potential to shed additional light on the relationships among social services, health status, health care use, and benefits to clients’ well-being. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Online Article: Applied Methods Source Type: research

Impact of Medicaid Expansion on Medicaid-covered Utilization of Buprenorphine for Opioid Use Disorder Treatment: Erratum
No abstract available (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Erratum Source Type: research

Missing Data in Marginal Structural Models: A Plasmode Simulation Study Comparing Multiple Imputation and Inverse Probability Weighting
Conclusions: Under simple yet realistically constructed scenarios, MI seems to confer an advantage over IPW in MSMs applications. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Original Articles Source Type: research

Effect of Home Medication Titration on Blood Pressure Control in Patients With Hypertension: A Meta-Analysis of Randomized Controlled Trials
Background: Medication titration has been used in home blood pressure (BP) control, with the expectation of enabling patients with hypertension to better manage their BP. Objective: The study goal was to estimate the effects of medication titration intervention in lowering the systolic blood pressure and diastolic blood pressure of patients with hypertension. Methods: The meta-analysis included randomized controlled trials on adults diagnosed with hypertension and BP≧130/80 mm Hg, having a medication-titration intervention, and using a home BP measurement. We systematically searched PubMed, CINAHL, ...
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Original Articles Source Type: research

Veterans’ Reliance on VA Care by Type of Service and Distance to VA for Nonelderly VA-Medicaid Dual Enrollees
Conclusions: Veterans dually enrolled in Medicaid received most of their outpatient care from the VA except ED, obstetrics/gynecology, and dental care. Patients received most of their inpatient care from Medicaid except mental health, respiratory, and cancer care. Sensitivity to travel distance to VA providers explained some of these differences. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Brief Report Source Type: research

How Much Does Medication Nonadherence Cost the Medicare Fee-for-Service Program?
Conclusion: Medication nonadherence places a large resource burden on the Medicare FFS program. Study results provide actionable information for policymakers considering programs to manage chronic conditions. Caution should be used in summing estimates across disease groups, assuming all nonadherent beneficiaries could become adherent, and applying estimates beyond the Medicare FFS population. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Original Article Source Type: research

Evaluation of a Medicaid Lock-in Program: Increased Use of Opioid Use Disorder Treatment but No Impact on Opioid Overdose Risk
We examined the immediate and sustained effects of a Medicaid LIP on overdose risk and use of medication-assisted treatment (MAT) for opioid use disorder. Methods: We analyzed North Carolina Medicaid claims from July 2009 through June 2013. We estimated daily risk differences and ratios of MAT use and overdose during lock-in and following release from the program, compared with periods before program enrollment. Results: The daily probability of MAT use during lock-in and following release was greater, when compared with a period just before LIP enrollment [daily risk ratios: 1.50, 95% confidence interval (CI): 1.18&...
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Brief Reports Source Type: research

Medicaid Expansion and Prescription Trends: Opioids, Addiction Therapies, and Other Drugs
Conclusions: Our results suggest Medicaid expansion benefited a population with unique needs, and that Medicaid expansion could be a valuable tool in addressing the opioid overdose epidemic. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Brief Reports Source Type: research

The Impacts of the ACA Medicaid Expansions on Cancer Screening Use by Primary Care Provider Supply
Conclusions: ACA Medicaid expansions were associated with increased cancer screening use only in states with high supply of primary care providers. Improving access for Medicaid beneficiaries in provider shortage areas may require coupling coverage expansions with supply-side interventions to increase provider availability. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Original Articles Source Type: research

Informal Clinical Integration in Medicare Accountable Care Organizations and Mortality Following Coronary Artery Bypass Graft Surgery
Background: Accountable care organizations’ (ACOs’) focus on formal clinical integration to improve outcomes overlooks actual patterns of provider interactions around shared patients. Objective: To determine whether such informal clinical integration relates to a health system’s performance in an ACO. Research Design: We analyzed national Medicare data (2008–2014), identifying beneficiaries who underwent coronary artery bypass grafting (CABG). After determining which physicians delivered care to them, we aggregated across episodes to construct physician networks for each health system. We us...
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Original Articles Source Type: research

Attitudes About Consumer Strategies Among Americans in High-deductible Health Plans
Conclusions: HDHP enrollees may not pursue consumer strategies because they believe they are not helpful for getting care or lowering costs. Providers and payers should ensure these strategies are actually helpful to HDHP enrollees and that enrollees understand how they could use these strategies to reduce their out-of-pocket costs. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Original Articles Source Type: research

Feasibility of Distinguishing Performance Among Provider Groups Using Patient-reported Outcome Measures in Older Adults With Multiple Chronic Conditions
Conclusions: Achieving acceptable reliability for these PMs and conditions would have required minimum sample sizes of 341 at the clinic level or 880 at the health plan level. These estimates can guide the design of future patient-reported outcome–based PMs. (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Original Articles Source Type: research

Feasibility and Value of Patient-reported Outcome Measures for Value-based Payment
No abstract available (Source: Medical Care)
Source: Medical Care - February 14, 2019 Category: Health Management Tags: Editorial Source Type: research

Comparison of Pharmacy Claims and Electronic Pill Bottles for Measurement of Medication Adherence Among Myocardial Infarction Patients
Conclusions: Pharmacy claims data provide useful but not complete data for medication adherence monitoring. New wireless technologies have the potential to provide additional data about clinical outcomes. (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Online Article: Applied Methods Source Type: research

Response to Letter Regarding Characteristics of State Policies Impact Health Care Delivery
No abstract available (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Letters to the Editor Source Type: research

Letter Regarding Characteristics of State Policies Impact Health Care Delivery
No abstract available (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Letters to the Editor Source Type: research

Response to The Methodological Challenges of Using Veterans Benefits Administration Disability Codes to Ascertain Agent Orange Exposure Among Vietnam Theater Veterans With Service-connected Disabilities
No abstract available (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Letters to the Editor Source Type: research

The Methodological Challenges of Using Veterans Benefits Administration Disability Codes to Ascertain Agent Orange Exposure Among Vietnam Theater Veterans With Service-connected Disabilities
No abstract available (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Letters to the Editor Source Type: research

Falsification Tests for Instrumental Variable Designs With an Application to Tendency to Operate
Background: Instrumental variable (IV) methods are becoming an increasingly important tool in health services research as they can provide consistent estimates of causal effects in the presence of unobserved confounding. However, investigators must provide justifications that the IV is independent with any unmeasured confounder and its effect on the outcome occurs only through receipt of the exposure. These assumptions, while plausible in some contexts, cannot be verified from the data. Methods: Falsification tests can be applied to provide evidence for the key IV assumptions. A falsification test cannot prove the ass...
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Statistical Workshop Source Type: research

Dissemination and Implementation of Patient-centered Indicators of Pain Care Quality and Outcomes
Background: Previous approaches to measuring and improving nursing-sensitive, patient-centered metrics of pain quality and outcomes in hospitalized patients have been limited. Methods: In this translational research study, we disseminated and implemented pain quality indicators in 1611 medical and/or surgical, step-down, rehabilitation, critical access, and obstetrical (postpartum) units from 326 US hospitals participating in the National Database of Nursing Quality Indicators. Eligible patients were English-speaking adults in pain. Trained nurses collected patients’ perceptions via structured interview includin...
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Patient-Centered Care Source Type: research

Psychometric Evaluation of an Instrument to Measure Prospective Pregnancy Preferences: The Desire to Avoid Pregnancy Scale
Conclusions: A robust measure is available to prospectively measure desire to avoid pregnancy. The measure can aid in identifying women who could benefit from contraceptive care and research on less desired pregnancy. (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Functional Status Is Associated With 30-Day Potentially Preventable Readmissions Following Home Health Care
Conclusions: Functional limitations at discharge from home health are associated with increased risk for potentially preventable readmissions. Future research is needed to determine whether improving functional independence decreases the risk for potentially preventable readmissions following home health care. (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Sexual Orientation Disparities in Physical Activity: Results From Insured Adults in California
Conclusions: We find that SMs get more frequent PA than their heterosexual peers, which suggests that the higher prevalence of obesity and other PA-related adverse health outcomes among SMs may be due to factors other than PA patterns. (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Role of Prices, Utilization, and Health in Explaining Texas Medicaid Newborn Care Spending Variation
Conclusions: Significant regional variations in price, utilization, and health status exist in Medicaid newborn care across Texas in 2014. Disentangling the effect of each driver is important to address spending variation and improve efficiency in newborn care. (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

Identification of Cross-sector Service Utilization Patterns Among Urban Medicaid Expansion Enrollees
Conclusions: Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes. (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Original Articles Source Type: research

The Effects of the Patient Protection and Affordable Care Act on Children’s Health Coverage
Conclusions: The PPACA resulted in a meaningful decline in children’s uninsured rate in Medicaid-expanding states. PPACA provisions targeting private coverage take-up offset crowd-out effects of the Medicaid expansions resulting in lower children’s uninsured rates. (Source: Medical Care)
Source: Medical Care - January 16, 2019 Category: Health Management Tags: Original Articles Source Type: research