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Journal Med Care

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Assessing Cancer Patient Experience of Care in Outpatient Oncology Practices in the United States.

Lindsey Roth, Manasi Tirodkar, Mark Friedberg, Aaron Smith-McLallen, Sarah Hudson Scholle,

INTRODUCTION:Cancer patients' experience of care is an important component of quality that has not previously been used for comparing performance. We administered a new patient experience survey to cancer patients receiving outpatient chemotherapy treatment. We examined its measures for sensitivity to adjustment for case-mix and response tendency (level of general ... Read more >>

Med Care (Medical care)
[2020, 58(8):744-748]

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Did the Affordable Care Act Decrease Veteran Enrollment in the Veterans Health Administration?

Abigail Silva, Elizabeth Tarlov, Beverly Gonzalez, Bridget M Smith, Dustin D French, Timothy P Hogan, Neil Jordan, Zhiping Huo, Rachael N Martinez, Dolores Ippolito, Kevin T Stroupe,

BACKGROUND:Provisions of the Affordable Care Act (ACA) provided nonelderly individuals, including Veterans, with additional health care coverage options. This may impact enrollment for health care through the Veterans Health Administration (VHA). National enrollment data was used to: (1) compare characteristics of enrollees at 3 time points in relation to the ... Read more >>

Med Care (Medical care)
[2020, 58(8):703-709]

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Utilization and Costs by Primary Care Provider Type: Are There Differences Among Diabetic Patients of Physicians, Nurse Practitioners, and Physician Assistants?

Valerie A Smith, Perri A Morgan, David Edelman, Sandra L Woolson, Theodore S Z Berkowitz, Courtney H Van Houtven, Cristina C Hendrix, Christine M Everett, Brandolyn S White, George L Jackson,

OBJECTIVE:The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs). RESEARCH DESIGN AND METHODS:Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and ... Read more >>

Med Care (Medical care)
[2020, 58(8):681-688]

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Hospital Length of Stay, Charges, and Costs Associated With a Diagnosis of Obesity in US Children and Youth, 2006-2016.

Lyudmyla Kompaniyets, Elizabeth A Lundeen, Brook Belay, Alyson B Goodman, Florence Tangka, Heidi M Blanck,

BACKGROUND:Childhood obesity is linked with adverse health outcomes and associated costs. Current information on the relationship between childhood obesity and inpatient costs is limited. OBJECTIVE:The objective of this study was to describe trends and quantify the link between childhood obesity diagnosis and hospitalization length of stay (LOS), costs, and charges. ... Read more >>

Med Care (Medical care)
[2020, 58(8):722-726]

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Early Performance of Hospital Value-based Purchasing Program in Medicare: A Systematic Review.

Young-Rock Hong, Oliver Nguyen, Sandhya Yadav, Emma Etzold, Jihee Song, R Paul Duncan, Kea Turner,

BACKGROUND:Under the Affordable Care Act, the Centers for Medicare and Medicaid Services has greatly expanded inpatient fee-for-value programs including the Hospital Value-based Purchasing (HVBP) program. Existing evidence from the HVBP program is mixed. There is a need for a systematic review of the HVBP program to inform discussions on how ... Read more >>

Med Care (Medical care)
[2020, 58(8):734-743]

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A Mixed Methods Study of the Association of Non-Veterans Affairs Care With Veterans' and Clinicians' Experiences of Care Coordination.

Justin K Benzer, Deborah Gurewich, Sara J Singer, Nathalie M McIntosh, David C Mohr, Varsha G Vimalananda, Martin P Charns,

BACKGROUND:Poor coordination between the Department of Veterans Affairs (VA) and non-VA care may negatively impact health care quality. Recent legislation is intended to increase Veterans' access to care, in part through increased use of non-VA care. However, a possible consequence may be diminished patient experiences of coordination. OBJECTIVE:The objective of ... Read more >>

Med Care (Medical care)
[2020, 58(8):696-702]

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Events Associated With Changes in Reliance on the Veterans Health Administration Among Medicare-eligible Veterans.

Paul L Hebert, Edwin S Wong, Ashok Reddy, Adam Batten, Eric Gunnink, Todd H Wagner, Chuan-Fen Liu,

OBJECTIVES:We can learn something about how Veterans value the Veterans Health Administration (VHA) versus community providers by observing Veterans' choices between VHA and Medicare providers after they turn 65. For a cohort of Veterans who were newly age-eligible for Medicare, we estimated the change in VHA reliance (VHA outpatient visits ... Read more >>

Med Care (Medical care)
[2020, 58(8):710-716]

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Financial Performance of Medicare Advantage Contracts in 2014 and Plan Renewal, Consolidation, and Termination Rates in the Subsequent Year.

Brent A Langellier, Sungchul Park,

BACKGROUND:Starting in 2014, the Affordable Care Act mandated that Medicare Advantage (MA) contracts spend at least 85% of total revenue on claims and quality improvement [ie, the medical loss ratio (MLR)] and submit revenue and cost data annually in MLR reports. These reports can improve transparency of the financial performance ... Read more >>

Med Care (Medical care)
[2020, 58(8):674-680]

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Emergency Medicaid Acquisition Through the Affordable Care Act: The Association Between Hospital Enrollment in California and Hospital Revenue.

Linda D Tran, Lisa M Knowlton, Todd H Wagner,

BACKGROUND:Hospital Presumptive Eligibility (HPE) is a national policy stemming from the Affordable Care Act that allows qualified hospitals, working with state officials, to enroll eligible patients for temporary Medicaid coverage. Although all states are required to operate an HPE program, hospital participation is elective and variable. It is unclear which ... Read more >>

Med Care (Medical care)
[2020, 58(8):727-733]

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Associations Between Complementary and Alternative Medicine and Health Care Expenditures Among Adults With Chronic Back Pain.

R Henry Olaisen,

BACKGROUND:Although complementary and alternative medicine (CAM) has been associated with reduced morbidity among adults with chronic back pain, less is known about the association between CAM use and health care expenditures. OBJECTIVES:The objective of this study was to first estimate health care expenditures of adult CAM users and nonusers with ... Read more >>

Med Care (Medical care)
[2020, 58(8):689-695]

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Effects of the Recent Medicaid Expansions on Dental Preventive Services and Treatments.

Wei Lyu, Dan M Shane, George L Wehby,

BACKGROUND:Low-income adults in the United States have historically had poor access to dental services largely due to limited dental coverage. OBJECTIVE:We examined the effects of recent Medicaid income-eligibility expansions under the Affordable Care Act on dental visits separately for preventive care and treatments. RESEARCH DESIGN:We used restricted data from the ... Read more >>

Med Care (Medical care)
[2020, 58(8):749-755]

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Comorbidity Assessment Is Uneven Across Veterans Health Administration and Medicare for the Same Patient: Implications for Risk Adjustment.

Risha Gidwani-Marszowski, Derek Boothroyd, Jack Needleman, Samantha Illarmo, Steven M Asch,

OBJECTIVE:Compare comorbidity identification in Medicare and Veterans Health Administration (VA) data for the purposes of risk adjustment. DATA SOURCES:Analysis of Medicare and VA datasets for dually-enrolled Veterans receiving care in both settings, fiscal years 2010-2014. STUDY DESIGN:A retrospective analysis of administrative data for a national sample of cancer decedents. DATA ... Read more >>

Med Care (Medical care)
[2020, 58(8):717-721]

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Cost-effectiveness of Investment in End-of-Life Home Care to Enable Death in Community Settings.

Sarina R Isenberg, Peter Tanuseputro, Sarah Spruin, Hsien Seow, Russell Goldman, Kednapa Thavorn, Amy T Hsu,

BACKGROUND:Many people with terminal illness prefer to die in home-like settings-including care homes, hospices, or palliative care units-rather than an acute care hospital. Home-based palliative care services can increase the likelihood of death in a community setting, but the provision of these services may increase costs relative to usual care. ... Read more >>

Med Care (Medical care)
[2020, 58(8):665-673]

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Medication Use and Health Care Utilization After a Cost-sharing Increase in Schizophrenia: A Nationwide Analysis.

Aleksi Hamina, Antti Tanskanen, Jari Tiihonen, Heidi Taipale,

BACKGROUND:Increases in prescription drug cost-sharing may decrease adherence to treatment among persons with schizophrenia and lead to discontinuation of use and an increased risk of hospitalization. OBJECTIVE:The objective of this study was to investigate the impact of new deductible and increased drug copayments implemented on antipsychotic and other drug purchases ... Read more >>

Med Care (Medical care)
[2020, :]

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Impact of the ACA Medicaid Expansion on Utilization of Mental Health Care.

Joshua Breslau, Bing Han, Julie Lai, Hao Yu,

BACKGROUND:The Affordable Care Act's Medicaid expansions (ME) increased insurance coverage for low-income Americans, among whom unmet need for mental health care is high. Empirical evidence regarding the impact of expanding insurance coverage on use of mental health services among low income and minority populations is lacking. METHODS:Data on mental health ... Read more >>

Med Care (Medical care)
[2020, :]

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National Evaluation of Patient Preferences in Selecting Hospitals and Health Care Providers.

Ryan J Ellis, Tarik K Yuce, Daniel B Hewitt, Ryan P Merkow, Christine V Kinnier, Julie K Johnson, Karl Y Bilimoria,

BACKGROUND:Patient utilization of public reporting has been suboptimal despite attempts to encourage use. Lack of utilization may be due to discordance between reported metrics and what patients want to know when making health care choices. OBJECTIVE:The objective of this study was to identify measures of quality that individuals want to ... Read more >>

Med Care (Medical care)
[2020, :]

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Health Care Costs of Alzheimer and Related Dementias Within a Medicare Managed Care Provider.

Paul A Fishman, Lindsay White, Bailey Ingraham, Sungchul Park, Eric B Larson, Paul Crane, Norma B Coe,

BACKGROUND:Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings. OBJECTIVE:The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within ... Read more >>

Med Care (Medical care)
[2020, :]

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Impact of a Follow-up Telephone Call Program on 30-Day Readmissions (FUTR-30): A Pragmatic Randomized Controlled Real-world Effectiveness Trial.

Maame Yaa A B Yiadom, Henry J Domenico, Daniel W Byrne, Michele Hasselblad, Sunil Kripalani, Neesha Choma, Sarah Tucker-Marlow, Cheryl L Gatto, Li Wang, Monisha C Bhatia, Johnston Morrison, Frank E Harrell, Tina V Hartert, Christopher J Lindsell, Gordon R Bernard,

BACKGROUND:Telephone call programs are a common intervention used to improve patients' transition to outpatient care after hospital discharge. OBJECTIVE:To examine the impact of a follow-up telephone call program as a readmission reduction initiative. RESEARCH DESIGN:Pragmatic randomized controlled real-world effectiveness trial. SUBJECTS:We enrolled and randomized all patients discharged home from a ... Read more >>

Med Care (Medical care)
[2020, :]

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The Average Effect of Emergency Department Admission on Readmission and Mortality for Older Adults With Chest Pain.

Sebastian A Alvarez Avendaño, Amy L Cochran, Brian Patterson, Manish Shah, Maureen Smith, Gabriel Zayas-Cabán,

BACKGROUND:Many older adults (65+) present to the Emergency Department (ED) with chest pain, but do not have otherwise clear clinical indication of whether they should be admitted or discharged. This uncertainty leads to decisions that are highly variable-in addition to already being costly-which could have adverse consequences, since older adults ... Read more >>

Med Care (Medical care)
[2020, :]

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Coverage for Adults With Chronic Disease Under the First 5 Years of the Affordable Care Act.

Rebecca Myerson, Samuel Crawford,

BACKGROUND:A key goal of the Patient Protection and Affordable Care Act (ACA) was to increase health insurance coverage for people with chronic disease. Little is known about progress toward this goal over the first 5 years of ACA implementation. OBJECTIVE:The objective of this study was to assess changes in coverage ... Read more >>

Med Care (Medical care)
[2020, :]

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An Economic Analysis of the Implementation of Team-based Collaborative Care in Outpatient General Mental Health Clinics.

Christopher J Miller, Kevin N Griffith, Kelly Stolzmann, Bo Kim, Samantha L Connolly, Mark S Bauer,

BACKGROUND:Collaborative Chronic Care Models represent an evidence-based way to structure care for chronic conditions, including mental health conditions. Few studies, however, have examined the cost implications of collaborative care for mental health. OBJECTIVE:We aimed to conduct an economic analysis of implementing collaborative care in 9 outpatient general mental health clinics. ... Read more >>

Med Care (Medical care)
[2020, :]

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Early Delays in Insurance Coverage and Long-term Use of Home-based Peritoneal Dialysis.

Eugene Lin, Glenn M Chertow, Jay Bhattacharya, Darius Lakdawalla,

BACKGROUND:Uninsured patients with end-stage renal disease face barriers to peritoneal dialysis (PD), a type of home dialysis that is associated with improved quality of life and reduced Medicare costs. Although uninsured patients using PD at dialysis start receive retroactive Medicare coverage for required predialysis services, coverage only applies for the ... Read more >>

Med Care (Medical care)
[2020, 58(7):632-642]

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Social Justice, Triage, and COVID-19: Ignore Life-years Saved.

John R Stone,

Med Care (Medical care)
[2020, 58(7):579-581]

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The Effect of Physical and Cognitive Impairments on Caregiving.

Eric Jutkowitz, Pedro Gozalo, Amal Trivedi, Lauren Mitchell, Joseph E Gaugler,

BACKGROUND:Many older adults receive caregiving; however, less is known about how a change in a care recipient's functional activity limitations [instrumental activities of daily living (IADL) and basic activities of daily living (ADL)] as well as their cognitive impairment influence the amount of caregiving received. METHODS:Using the Health and Retirement ... Read more >>

Med Care (Medical care)
[2020, 58(7):601-609]

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Estimating the Net Benefit of Improvements in Hospital Performance: G-Computation With Hierarchical Regression Models.

Peter C Austin, Douglas S Lee,

BACKGROUND:It is important to be able to estimate the anticipated net population benefit if the performance of hospitals is improved to specific standards. OBJECTIVE:The objective of this study was to show how G-computation can be used with random effects logistic regression models to estimate the absolute reduction in the number ... Read more >>

Med Care (Medical care)
[2020, 58(7):651-657]

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