Ari Ne'eman
OBJECTIVE: To understand trends in the long-term services and supports (LTSS) workforce and assess workforce data as a measure of progress in shifting LTSS resources from institutional to community-based settings. DATA SOURCES/STUDY SETTING: Workforce data from the American Community Survey from 2008 to 2022. STUDY DESIGN: Measures of LTSS rebalancing and institutional and community workforce supply per 1000 persons with LTSS needs were constructed...
February 21, 2024: Health Services Research
Saumya Chatrath, Eugene C Rich, Ann S O'Malley, Genna Cohen, David J Jones
OBJECTIVE: To test the reliability of Medicare claims in measuring vertical integration. We assess the accuracy of a commonly used measure of integration, primary care physician (PCP) practices billing Medicare as a hospital outpatient department (HOPD) in claims. DATA SOURCES AND STUDY SETTING: Medicare fee-for-service claims, IQVIA, and CPC+ practice surveys for this study. STUDY DESIGN: We compare measures of integration from Medicare claims to self-reported indicators of integration from IQVIA and a survey of CPC+ participating practice sites...
January 29, 2024: Health Services Research
Zijing Cheng, Espérance Mutoniwase, Xueya Cai, Yue Li
OBJECTIVE: To examine the relationship between the level of state funding for Home- and Community-Based Services (HCBS) and state overall and dimension-specific performances in Long-Term Services and Supports (LTSS). DATA SOURCES AND STUDY SETTING: We employed state-level secondary data from the Medicaid LTSS Annual Expenditures Reports, the American Association of Retired Persons (AARP) State Scorecards, the U.S. Census, and Federal Reserve Economic data, spanning the timeframe of 2010-2020...
January 29, 2024: Health Services Research
Eric Rubenstein, Salina Tewolde, A Alex Levine, Lillian Droscha, Rachel Midori Meyer, Amy Michals, Brian Skotko
OBJECTIVE: Given high rates of un- and underemployment among disabled people, adults with intellectual and developmental disabilities rely on Medicaid, Medicare, or both to pay for healthcare. Many disabled adults are Medicare eligible before the age of 65 but little is known as to why some receive Medicare services while others do not. We described the duration of Medicare enrollment for adults with intellectual and developmental disabilities in 2019 and then compared demographics by enrollment type (Medicare-only, Medicaid-only, dual-enrolled)...
January 24, 2024: Health Services Research
Joanne Pascale, Angela R Fertig, Kathleen Thiede Call
OBJECTIVE: To evaluate the veracity of self-reports of month-level health insurance coverage in the Current Population Survey Annual Social and Economic Supplement (CPS). DATA SOURCES AND STUDY SETTING: The CHIME (Comparing Health Insurance Measurement Error) study used health insurance enrollment records from a large regional Midwest insurer as sample for primary data collection in spring 2015. STUDY DESIGN: A sample of individuals enrolled in a range of public and private coverage types (including Medicaid and marketplace) was administered the CPS health insurance module, which included questions about month-level coverage, by type, over a 17-18-month time span...
January 23, 2024: Health Services Research
Jana Bilger, Mark Pletscher, Tobias Müller
OBJECTIVE: To measure hospital quality based on routine data available in many health care systems including the United States, Germany, the United Kingdom, Scandinavia, and Switzerland. DATA SOURCES AND STUDY SETTING: We use the Swiss Medical Statistics of Hospitals, an administrative hospital dataset of all inpatient stays in acute care hospitals in Switzerland for the years 2017-2019. STUDY DESIGN: We study hospital quality based on quality indicators used by leading agencies in five countries (the United States, the United Kingdom, Germany, Austria, and Switzerland) for two high-volume elective procedures: inguinal hernia repair and hip replacement surgery...
January 22, 2024: Health Services Research
Patrick N O'Mahen, Chase S Eck, Cheng Rebecca Jiang, Laura A Petersen
OBJECTIVE: To evaluate changes in dual enrollment after Affordable Care Act Medicaid expansion by VA priority group, (e.g., service connection), sex, and type of state expansion. STUDY SETTING: Our cohort was all Veterans ages 18-64 enrolled in VA and eligible for benefits due to military service-connection or low income from 2011 to 2016; the unit of analysis was person-year. STUDY DESIGN: Difference-in-difference and event-study analysis...
January 22, 2024: Health Services Research
Leslie R M Hausmann, David E Goodrich, Keri L Rodriguez, Nicole Beyer, Zachary Michaels, Gilly Cantor, Nicholas Armstrong, Johanne Eliacin, Deborah A Gurewich, Alicia J Cohen, Maria K Mor
OBJECTIVE: To understand the determinants and benefits of cross-sector partnerships between Veterans Affairs Medical Centers (VAMCs) and geographically affiliated AmericaServes Network coordination centers that address Veteran health-related social needs. DATA SOURCES AND SETTING: Semi-structured interviews were conducted with AmericaServes and VAMC staff across seven regional networks. We matched administrative data to calculate the percentage of AmericaServes referrals that were successfully resolved (i...
January 22, 2024: Health Services Research
Hussain S Lalani, Massimilano Russo, Rishi J Desai, Aaron S Kesselheim, Benjamin N Rome
OBJECTIVE: To determine whether annual changes in prices for clinician-administered drugs are associated with changes in patient out-of-pocket costs. DATA SOURCES AND STUDY SETTING: National commercial claims database, 2009 to 2018. STUDY DESIGN: In a serial, cross-sectional study, we calculated the annual percent change in manufacturer list prices and net prices after rebates. We used two-part generalized linear models to assess the relationship between annual changes in price with (1) the percentage of individuals incurring any out-of-pocket costs and (2) the percent change in median non-zero out-of-pocket costs...
January 21, 2024: Health Services Research
Kathleen Carey, Megan B Cole
OBJECTIVES: To examine whether community health centers (CHCs) are effective in offsetting mental health emergency department (ED) visits. DATA SOURCES AND STUDY SETTING: The HRSA Uniform Data System and the HCUP State ED Databases for Florida patients during 2012-2019. STUDY DESIGN: We identified CHC-year-specific service areas using patient origin zip codes. We then estimated panel data models for number of ED mental health visits per capita in a CHC's service area...
January 20, 2024: Health Services Research
Ceshae C Harding, Karen M Goldstein, Sarah A Goldstein, Sarahn M Wheeler, Nia S Mitchell, Laurel A Copeland
OBJECTIVE: To describe the prevalence of maternal chronic hypertension (MCH), assess how frequently blood pressure is controlled before pregnancy among those with MCH, and explore management practices for antihypertensive medications (AHM) during the pre-pregnancy and pregnancy periods. DATA SOURCES, STUDY SETTING, AND STUDY DESIGN: We conducted a descriptive observational study using data abstracted from the Veterans Health Administration (VA) inclusive of approximately 11 million Veterans utilizing the VA in fiscal years 2010-2019...
January 17, 2024: Health Services Research
Betsy Q Cliff, Julia C P Eddelbuettel, Mark K Meiselbach, Matthew D Eisenberg
OBJECTIVE: To validate imputation methods used to infer plan-level deductibles and determine which enrollees are in high-deductible health plans (HDHPs) in administrative claims datasets. DATA SOURCES AND STUDY SETTING: 2017 medical and pharmaceutical claims from OptumLabs Data Warehouse for US individuals <65 continuously enrolled in an employer-sponsored plan. Data include enrollee and plan characteristics, deductible spending, plan spending, and actual plan-level deductibles...
January 17, 2024: Health Services Research
Janna M Wisniewski, Brigham Walker, Isha Patlola, Rajiv Sharma, Sarah Tinkler
OBJECTIVE: To measure differences in access to contraceptive services based on history of incarceration and its intersections with race/ethnicity and insurance status. DATA SOURCES AND STUDY SETTING: Primary data were collected from telephone calls to physician offices in Alabama, Louisiana, and Mississippi in 2021. STUDY DESIGN: We deployed a field experiment. The outcome variables were appointment offers, wait days, and questions asked of the caller...
January 17, 2024: Health Services Research
Charleen Hsuan, David J Vanness, Alexis Zebrowski, Brendan G Carr, Edward C Norton, David G Buckler, Yinan Wang, Douglas L Leslie, Eleanor F Dunham, Jeannette A Rogowski
OBJECTIVE: To examine racial/ethnic differences in emergency department (ED) transfers to public hospitals and factors explaining these differences. DATA SOURCES AND STUDY SETTING: ED and inpatient data from the Healthcare Cost and Utilization Project for Florida (2010-2019); American Hospital Association Annual Survey (2009-2018). STUDY DESIGN: Logistic regression examined race/ethnicity and payer on the likelihood of transfer to a public hospital among transferred ED patients...
January 17, 2024: Health Services Research
Daniel Marthey, Hannah Rochford, Elena Andreyeva
OBJECTIVE: To examine the effect of Medicaid immediate postpartum long-acting reversible contraception (IPP LARC) reforms on self-reported mental health among low-income mothers aged 18-44 years. DATA SOURCES AND STUDY SETTING: We used national secondary data on self-reported mental health status in the past 30 days from the core component (2014-2019) of the Behavioral Risk Factor Surveillance System (BRFSS). STUDY DESIGN: We estimated linear probability models for reporting any days of not good mental health in the past 30 days...
January 11, 2024: Health Services Research
Caroline S Carlin, Roger Feldman, Jeah Jung
OBJECTIVE: To study diagnosis coding intensity across Medicare programs, and to examine the impacts of changes in the risk model adopted by the Centers for Medicare and Medicaid Services (CMS) for 2024. DATA SOURCES AND STUDY SETTING: Claims and encounter data from the CMS data warehouse for Traditional Medicare (TM) beneficiaries and Medicare Advantage (MA) enrollees. STUDY DESIGN: We created cohorts of MA enrollees, TM beneficiaries attributed to Accountable Care Organizations (ACOs), and TM non-ACO beneficiaries...
January 11, 2024: Health Services Research
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January 9, 2024: Health Services Research
Jason B Gibbons, Wenshu Li, Elizabeth A Stuart, Brendan Saloner
OBJECTIVE: To model the potential impact of mobile methadone unit implementation in Louisiana on net medication for opioid use disorder (MOUD) treatment rates. DATA SOURCES/STUDY SETTING: We use secondary Louisiana Medicaid claims data between 2020 and 2021. STUDY DESIGN: We simulate the impact of mobile methadone units in Louisiana using two approaches: (1) a "Poisson regression approach," which predicts the number of opioid use disorder (OUD) patients that might use methadone at mobile locations based on the underlying association between methadone use and proximity to a brick-and-mortar methadone clinic; (2) a "policy approach," which leverages local treatment uptake rates following the expansion of methadone coverage to Louisiana Medicaid beneficiaries in 2020 to estimate methadone use following mobile unit implementation...
January 8, 2024: Health Services Research
Dana B Mukamel, Heather Ladd, Debra Saliba, R Tamara Konetzka
OBJECTIVE: To estimate and contrast the relationships between nurse staffing and health outcomes in nursing homes with low and high dementia census, to understand the association of staffing hours with dementia care quality. DATA SOURCES AND STUDY SETTING: A national sample of nursing homes during 2017-2019 (pre-COVID). Data included the Payroll-Based Journal, Medicare Claims, Nursing Home Care Compare, and Long-Term Care Focus. STUDY DESIGN: Retrospective, regression analyses...
December 29, 2023: Health Services Research
Yulin Yang, Ah-Reum Lee, Thomas Rapp, Ruijia Chen, M Maria Glymour, Jacqueline M Torres
OBJECTIVE: To test whether the impacts of Medicaid's Home and Community-Based Services (HCBS) expenditures have been equitable. DATA SOURCES AND STUDY SETTING: This is a secondary data analysis. We linked annual data on state-level Medicaid HCBS expenditures with individual data from U.S. Health and Retirement Study (HRS; 2006-2016). STUDY DESIGN: We evaluated the association between state-level HCBS expenditure quartiles and the risk of experiencing challenges in basic or instrumental activities of daily living (I/ADLs) without assistance (unmet needs for care)...
December 26, 2023: Health Services Research
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