Health Services Research

OBJECTIVE: To examine whether Medicaid managed care plan (MCP) utilization management policies for buprenorphine-naloxone and injectable naltrexone are related to key state Medicaid program policy decisions. DATA SOURCES AND STUDY SETTING: We abstracted data on state Medicaid regulatory and policy information from publicly available sources and publicly available insurance benefit documentation from all 241 Medicaid MCPs operating in 2021. STUDY DESIGN: In this cross-sectional study, we used bivariate and multivariate analyses to examine whether Medicaid MCP prior authorization and quantity limits on receipt of buprenorphine and injectable naltrexone were associated with key state Medicaid choices to leverage federal funds to expand coverage and eligibility (Medicaid expansion, 1115 waivers) and to regulate Medicaid MCPs (uniform preferred drug lists, medical loss ratio remittance)...

OBJECTIVE: To understand why American Indian and Alaskan Native (AIAN) populations have had exceptionally high COVID-19 mortality, we compare patterns of healthcare utilization and outcomes for two serious infectious respiratory diseases-Influenza-like-illness (ILI) and coronavirus disease 2019 (COVID-19)-between American Indian and Alaskan Native (AIAN) populations (as identified in Medicaid data) and non-Hispanic Whites over the 2009-2021 period. STUDY SETTING AND DESIGN: We select all people under the age of 65 years identified as non-Hispanic White or AIAN in the New York State Medicaid claims data between 2009 and 2021...

OBJECTIVE: To examine differences in access to care and financial burden between Traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries in rural and urban areas and then explore whether there were potential differences in MA benefits between urban and rural areas. STUDY SETTING AND DESIGN: We conducted a cross-sectional study within the Medicare setting in the United States. DATA SOURCES AND ANALYTICAL SAMPLE: Data from three distinct sources for 2017-2021: the Medicare Current Beneficiary Survey, the MA landscape data, and the Plan Benefit Package data...

OBJECTIVE: To estimate differences in facility-level outcomes between nursing homes which reached Institutional Special Needs Plan (I-SNP) maturity and those which never cared for I-SNP enrollees. STUDY SETTING AND DESIGN: We used a difference-in-differences design to estimate the effect of I-SNP maturity, defined as having at least 33.75% of Medicare long-stayers in the nursing home enrolled in any I-SNP. Our main outcome was the hospitalization rate in each nursing home-year...

OBJECTIVE: To examine how lung cancer screening (LCS) is coordinated across healthcare systems, specifically Veterans Affairs (VA) and non-VA settings. DATA SOURCES AND STUDY SETTING: We conducted primary qualitative data collection in six VA medical centers with established LCS programs from November 2020 to November 2021. STUDY DESIGN AND DATA COLLECTION METHODS: Semi-structured interviews were conducted with 48 primary care providers, LCS program coordinators and directors, and pulmonologists...

OBJECTIVE: To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. DATA SOURCES AND STUDY SETTING: Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). STUDY DESIGN: Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

OBJECTIVE: To examine the association between hospital-cardiologist integration and Medicare spending for stable angina patients. DATA SOURCES AND STUDY SETTING: This study used Medicare Standard Analytic Files from 2013 to 2020 and the Centers for Medicare and Medicaid Services National Downloadable File for accompanying physician data. STUDY DESIGN: This was a retrospective cohort study of Medicare beneficiaries with a new diagnosis of stable angina between 2013 and 2020...

OBJECTIVE: To quantify disruptions in hospitalization and ambulatory care throughout the coronavirus disease 2019 (COVID-19) pandemic for 32 countries, and examine associations of health system characteristics and COVID-19 response strategies on disruptions. DATA SOURCES: We utilized aggregated inpatient hospitalization and surgical procedure data from the Organization for Economic Co-operation and Development Health Database from 2010 to 2021. Covariate data were extracted from the Organization for Economic Co-operation and Development Health Database, World Health Organization, and Oxford COVID-19 Government Response Tracker...

OBJECTIVE: To develop a method of consistently identifying interfacility transfers (IFTs) in Medicare Claims using patients with ST-Elevation Myocardial Infarction (STEMI) as an example. DATA SOURCES/STUDY SETTING: 100% Medicare inpatient and outpatient Standard Analytic Files and 5% Carrier Files, 2011-2020. STUDY DESIGN: Observational, cross-sectional comparison of patient characteristics between proposed and existing methods. DATA COLLECTION/EXTRACTION METHODS: We limited to patients aged 65+ with STEMI diagnosis using both proposed and existing methods...

No abstract text is available yet for this article.

OBJECTIVE: To assess the effectiveness of evidence-based quality improvement (EBQI) as an implementation strategy to expand the use of medications for opioid use disorder (MOUD) within nonspecialty settings. DATA SOURCES AND STUDY SETTING: We studied eight facilities in one Veteran Health Administration (VHA) region from October 2015 to September 2022 using administrative data. STUDY DESIGN: Initially a pilot, we sequentially engaged seven of eight facilities from April 2018 to September 2022 using EBQI, consisting of multilevel stakeholder engagement, technical support, practice facilitation, and data feedback...

OBJECTIVE: To examine racial inequities in low-risk and high-risk (or "medically appropriate") cesarean delivery rates in New Jersey during the era surrounding the United States cesarean surge and peak. STUDY SETTING AND DESIGN: This retrospective repeated cross-sectional study examined the universe of childbirth hospitalizations in New Jersey from January 1, 2000 through September 30, 2015. We estimate the likelihood of cesarean delivery by maternal race and ethnicity, with mixed-level logistic regression models, stratified by cesarean risk level designated by the Society of Maternal Fetal Medicine (SMFM)...

OBJECTIVE: To evaluate if state death investigation systems affect the reporting of suicides, particularly when comparing medical examiners to coroners. DATA SOURCES AND STUDY SETTING: We used restricted-access state mortality data from National Vital Statistics System between the years 1959 to 2016. These data were matched with state-level changes in death investigation systems reported by the Centers for Disease Control and Prevention database on the Public Health Law Program: Coroner/ME Laws...

OBJECTIVE: To compare theoretical strengths and limitations of common immortal time adjustment methods, propose a new approach using multiple imputation (MI), and provide practical guidance for using MI in precision medicine evaluations centered on a real-world case study. STUDY SETTING AND DESIGN: Methods comparison, guidance, and real-world case study based on previous literature. We compared landmark analysis, time-distribution matching, time-dependent analysis, and our proposed MI application...

OBJECTIVE: To use a practical approach to examining the use of Expert Recommendations for Implementing Change (ERIC) strategies by Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) dimensions for rural health innovations using annual reports on a diverse array of initiatives. DATA SOURCES AND STUDY SETTING: The Veterans Affairs (VA) Office of Rural Health (ORH) funds initiatives designed to support the implementation and spread of innovations and evidence-based programs and practices to improve the health of rural Veterans...

OBJECTIVE: To generate evidence regarding the offensive (customer acquisition) versus defensive (customer retention) motivation for pharmaceutical manufacturer coupons. DATA SOURCES AND STUDY SETTING: Retail prescriptions from IQVIA's Formulary Impact Analyzer data between 2017 and 2019. STUDY DESIGN: Ordinary least squares regression models with person, therapeutic class, drug, and time-fixed effects to measure the association between switching medications and coupon usage as well as the association between patient out-of-pocket spending and switching to a drug and using a coupon...

OBJECTIVE: To compare morbidity burden captured from multimorbidity indices and aggregated measures of clinically meaningful categories captured in primary care community-based health center (CBHC) patients. DATA SOURCES AND STUDY SETTING: Electronic health records of patients seen in 2019 in OCHIN's national network of CBHCs serving patients in rural and underserved communities. STUDY DESIGN: Age-stratified analyses comparing the most common conditions captured by the Charlson, Elixhauser, and Multimorbidity Weighted (MWI) indices, and Classification Software Refined (CCSR) and Chronic Condition Indicator (CCI) algorithms...

OBJECTIVE: To understand whether and how primary care providers and staff elicit patients' past experiences of healthcare discrimination when providing care. DATA SOURCES/STUDY SETTING: Twenty qualitative semi-structured interviews were conducted with healthcare staff in primary care roles to inform future interventions to integrate data about past experiences of healthcare discrimination into clinical care. STUDY DESIGN: Qualitative study...