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Medical Care

Lidia M V R Moura, Jason R Smith, Deborah Blacker, Christine Vogeli, Lee H Schwamm, Andrew J Cole, Sonia Hernandez-Diaz, John Hsu
BACKGROUND: Uncertain validity of epilepsy diagnoses within health insurance claims and other large datasets have hindered efforts to study and monitor care at the population level. OBJECTIVES: To develop and validate prediction models using longitudinal Medicare administrative data to identify patients with actual epilepsy among those with the diagnosis. RESEARCH DESIGN, SUBJECTS, MEASURES: We used linked electronic health records and Medicare administrative data including claims to predict epilepsy status...
February 12, 2019: Medical Care
Andrew J Admon, Thomas S Valley, John Z Ayanian, Theodore J Iwashyna, Colin R Cooke, Renuka Tipirneni
BACKGROUND: Medicaid expansion was associated with an increase in hospitalizations funded by Medicaid. Whether this increase reflects an isolated payer shift or broader changes in case-mix among hospitalized adults remains uncertain. RESEEARCH DESIGN: Difference-in-differences analysis of discharge data from 4 states that expanded Medicaid in 2014 (Arizona, Iowa, New Jersey, and Washington) and 3 comparison states that did not (North Carolina, Nebraska, and Wisconsin)...
February 12, 2019: Medical Care
Jennifer T Lloyd, Sha Maresh, Christopher A Powers, William H Shrank, Dawn E Alley
BACKGROUND: Medication adherence is associated with lower health care utilization and savings in specific patient populations; however, few empirical estimates exist at the population level. OBJECTIVE: The main objective of this study was to apply a data-driven approach to obtain population-level estimates of the impact of medication nonadherence among Medicare beneficiaries with chronic conditions. RESEARCH DESIGN: Medicare fee-for-service (FFS) claims data were used to calculate the prevalence of medication nonadherence among individuals with diabetes, heart failure, hypertension, and hyperlipidemia...
January 22, 2019: Medical Care
Jean Yoon, Megan E Vanneman, Sharon K Dally, Amal N Trivedi, Ciaran S Phibbs
BACKGROUND: Not much is known about nonelderly veterans and their reliance on care from the Veterans Affairs (VA) health care system when they have access to non-VA care. OBJECTIVES: To estimate VA reliance for nonelderly veterans enrolled in VA and Medicaid. RESEARCH DESIGN: Retrospective, longitudinal analysis of Medicaid claims data and VA administrative data to compare patients' utilization of VA and Medicaid services 12 months before and for up to 12 months after Medicaid enrollment began...
January 22, 2019: Medical Care
Michael O Harhay, Sarah J Ratcliffe, Dylan S Small, Leah H Suttner, Michael J Crowther, Scott D Halpern
BACKGROUND: In randomized clinical trials among critically ill patients, it is uncertain how choices regarding the measurement and analysis of nonmortal outcomes measured in terms of duration, such as intensive care unit (ICU) length of stay (LOS), affect studies' conclusions. OBJECTIVES: Assess the definitions and analytic methods used for ICU LOS analyses in published randomized clinical trials. RESEARCH DESIGN: This is a systematic review and statistical simulation study...
January 16, 2019: Medical Care
Dana Gelb Safran
No abstract text is available yet for this article.
January 16, 2019: Medical Care
Shao-Hsien Liu, Stavroula A Chrysanthopoulou, Qiuzhi Chang, Jacob N Hunnicutt, Kate L Lapane
BACKGROUND: The use of marginal structural models (MSMs) to adjust for time-varying confounding has increased in epidemiologic studies. However, in the setting of MSMs, recommendations for how best to handle missing data are contradictory. We present a plasmode simulation study to compare the validity and precision of MSMs estimates using complete case analysis (CC), multiple imputation (MI), and inverse probability weighting (IPW) in the presence of missing data on time-independent and time-varying confounders...
January 16, 2019: Medical Care
Betsy Q Cliff, Christopher Krenz, Brady T West, Helen Levy, A Mark Fendrick, Tyler N A Winkelman, Jonathan So, Angela Fagerlin, Jeffrey T Kullgren
BACKGROUND: More than 70 million Americans are enrolled in a high-deductible health plan (HDHP), with high upfront cost-sharing to encourage strategies such as price shopping to mitigate out-of-pocket spending. Recent research suggests HDHP enrollees are reluctant to engage in these consumer strategies, but there is little information on why. OBJECTIVES: To describe associations between HDHP enrollees' attitudes about and intent to engage in consumer strategies...
January 16, 2019: Medical Care
Benjamin A Y Cher, Nancy E Morden, Ellen Meara
BACKGROUND: Opioid overdose deaths in the United States have climbed since 1999. In 2014, the Affordable Care Act prompted some states to expand Medicaid programs, providing low-cost prescription access to millions of Americans. Some have questioned whether Medicaid expansion might worsen the opioid crisis. OBJECTIVE: To test the association between the expansion of state Medicaid programs and Medicaid-paid prescriptions of opioid pain relievers and opioid addiction therapies...
January 8, 2019: Medical Care
Dennie Kim, Russell J Funk, Phyllis Yan, Brahmajee K Nallamothu, Aks Zaheer, John M Hollingsworth
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)...
January 8, 2019: Medical Care
Rebecca B Naumann, Andrew W Roberts, Stephen W Marshall, Asheley C Skinner
BACKGROUND: "Lock-in" programs (LIPs) identify beneficiaries demonstrating potential overutilization of opioids, and other controlled substances, and restrict their access to these medications. LIPs are expanding to address the opioid crisis and could be an effective tool for connecting people to opioid use disorder treatment. 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...
January 8, 2019: Medical Care
Wei Lyu, George L Wehby
BACKGROUND: Recent studies of the impacts of the Affordable Care Act (ACA) Medicaid expansions on cancer screening use have mostly found insignificant effects. We posit that these findings mask meaningful heterogeneity in impacts depending on availability of primary care providers. OBJECTIVE: This study examined the impacts of the ACA Medicaid expansions on cancer screening use separately by state-level supply of primary care providers. RESEARCH DESIGN: We used data from the 2012 and 2016 Behavioral Risk Factor Surveillance System surveys to measure use of mammograms, Pap smear tests, blood stool tests, and sigmoidoscopy/colonoscopy for age groups recommended receiving these tests...
January 7, 2019: Medical Care
Adi J Klil-Drori, Dwip Prajapati, Zhiying Liang, Meng Wang, Dominique Toupin, Latifah Alothman, Eddy Lang, Deepa Suryanarayan, Vicky Tagalakis
BACKGROUND: Administrative health care databases are increasingly being used to study pulmonary embolism (PE), but the validity of single PE codes is variable. Using data from Quebec, Canada, we developed ASPECT (Algorithm for Suspected Pulmonary Embolism Confirmation and Treatment), combining 3 components to ascertain confirmed PE: emergency department (ED) diagnoses, imaging codes, and dispensed prescriptions or hospital diagnoses. Herein, we used unrelated administrative health care databases to externally validate ASPECT...
January 2, 2019: Medical Care
Susan L Beck, Nancy Dunton, Patricia H Berry, Jeannine M Brant, Jia-Wen Guo, Catima Potter, Beth Spornitz, Jacqueline Eaton, Bob Wong
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...
December 18, 2018: Medical Care
Rui Li, Brenda Bauman, Denise V D'Angelo, Leslie L Harrison, Lee Warner, Wanda Barfield, Shanna Cox
BACKGROUND: The Affordable Care Act (ACA)-dependent coverage Provision (the Provision), implemented in 2010, extended family insurance coverage to adult children until age 26. OBJECTIVES: To examine the impact of the ACA Provision on insurance coverage and care among women with a recent live birth. RESEARCH DESIGN, SUBJECTS, AND OUTCOME MEASURES: We conducted a difference-in-difference analysis to assess the effect of the Provision using data from the Pregnancy Risk Assessment Monitoring System among 22,599 women aged 19-25 (treatment group) and 22,361 women aged 27-31 years (control group)...
December 18, 2018: Medical Care
Corinne H Rocca, Lauren J Ralph, Mark Wilson, Heather Gould, Diana G Foster
BACKGROUND: Existing approaches to measuring women's pregnancy intentions suffer important limitations, including retrospective assessment, overly simple categories, and a presumption that all women plan pregnancies. No psychometrically valid scales exist to prospectively measure the ranges of women's pregnancy preferences. MATERIALS AND METHODS: Using a rigorous construct modeling approach, we developed a scale to measure desire to avoid pregnancy. We developed 60 draft items from existing research, assessed comprehension through 25 cognitive interviews, and administered items in surveys with 594 nonpregnant women in 7 primary and reproductive health care facilities in Arizona, New Jersey, New Mexico, South Carolina, and Texas in 2016-2017...
December 13, 2018: Medical Care
Kathi Mooney, Meagan S Whisenant, Susan L Beck
INTRODUCTION: There is growing recognition that systematically obtaining the patient's perspective on their health experience, using patient-reported outcomes (PRO), can be used to improve patient care in real time. Few PRO systems are designed to monitor and provide symptom management support between visits. Patients are instructed to contact providers between visits with their concerns, but they rarely do, leaving patients to cope with symptoms alone at home. We developed and tested an automated system, Symptom Care at Home (SCH), to address this gap in tracking and responding to PRO data in-between clinic visits...
December 10, 2018: Medical Care
Addie Middleton, Brian Downer, Allen Haas, Sara Knox, Kenneth J Ottenbacher
BACKGROUND: Beginning in 2019, home health agencies' rates of potentially preventable hospital readmissions over the 30 days following discharge will be publicly reported. OBJECTIVES: Our primary objective was to determine the association between patients' functional status at discharge from home health care and 30-day potentially preventable readmissions. A secondary objective was to identify the most common conditions resulting in potentially preventable readmissions...
December 10, 2018: Medical Care
Jacob W Dembosky, Amelia M Haviland, Ann Haas, Katrin Hambarsoomian, Robert Weech-Maldonado, Shondelle M Wilson-Frederick, Sarah Gaillot, Marc N Elliott
BACKGROUND: Researchers are increasingly interested in measuring race/ethnicity, but some survey respondents skip race/ethnicity items. OBJECTIVES: The main objectives of this study were to investigate the extent to which racial/ethnic groups differ in skipping race/ethnicity survey items, the degree to which this reflects reluctance to disclose race/ethnicity, and the utility of imputing missing race/ethnicity. RESEARCH DESIGN: We applied a previously developed method for imputing race/ethnicity from administrative data (Medicare Bayesian Improved Surname and Geocoding 2...
December 4, 2018: Medical Care
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