“Author Archive”
Stories written by Health Services Research
By Health Services Research
Objective To examine whether hospitals where patients obtain care explain racial/ethnic differences in treatment delay. Data Source Surveillance, Epidemiology, and End Results data linked with Medicare claims. Study Design We examined delays in adjuvant chemotherapy or radiation for women diagnosed with stage I–III breast cancer during 1992–2007. We used multivariable logistic regression to assess the probability of delay by race/ethnicity and included hospital fixed effects to assess whether hospitals explained disparities. Principal Findings Among 54,592 women, black (11.9 percent) and Hispanic (9.9 percent) women had more delays than whites (7.8 percent, p < .0001).
May 13th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To determine whether outcome disparities between black and white trauma patients have decreased over the last 10 years. Data Source Pennsylvania Trauma Outcome Study. Study Design We performed an observational cohort study on 191,887 patients admitted to 28 Level 1 and Level II trauma centers. The main outcomes of interest were (1) death, (2) death or major complication, and (3) failure-to-rescue. Hospitals were categorized according to the proportion of black patients.
May 13th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To develop a tool for estimating hospital-specific inpatient prices for major payers. Data Sources AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. Study Design Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources. Principal Findings Hospital prices can be reasonably estimated for 10 geographically diverse states
May 13th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers’ compensation during 2003–2006, and to identify demographic and clinical correlates of such visits. Data Source A total of 3,881 work-related emergency department visit records drawn from the 2003–2006 National Hospital Ambulatory Medical Care Surveys. Study Design Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression.
May 13th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective There is limited information on the protective value of Medicare Part D low-income subsidies (LIS). We compared responses to drug costs for LIS recipients with near-poor (200 percent of the Federal Poverty Level) and higher income beneficiaries without the LIS. Data Sources/Study Setting Medicare Advantage beneficiaries in 2008. Study Design We examined three drug cost responses using multivariate logistic regression: cost-reducing behaviors (e.g., switching to generics), nonadherence (e.g., not refilling prescriptions), and financial stress (e.g., going without necessities). Data Collection Telephone interviews in a stratified random sample (N = 1,201, 70 percent response rate).
May 13th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective This study presents evidence on how the dependent provision in the Affordable Care Act (ACA) differentially affected coverage for young adults across states and population subgroups. Study Design/Methods/Data The data derive from the American Community Survey. Using a difference-in-difference design, we compare the target population (ages 19–25) with a control group (ages 26–29). Principal Findings Net private health insurance coverage increased by 4.6 percentage points and overall coverage increased by 4.2 percentage points for people aged 19–25; more for Whites than non-White subgroups. Conclusions and Implications Changes in coverage for states appear driven by demographics rather than the existence of prior dependent expansions by the state
May 13th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
See the original post - Nonresponse Rates are a Problematic Indicator of Nonresponse Bias in Survey…
May 9th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To estimate the effect of a midwifery model of care delivered in a freestanding birth center on maternal and infant outcomes when compared with conventional care. Data Sources/Study Setting Birth certificate data for women who gave birth in Washington D.C. and D.C. residents who gave birth in other jurisdictions. Study Design Using propensity score modeling and instrumental variable analysis, we compare maternal and infant outcomes among women who receive prenatal care from birth center midwives and women who receive usual care
April 16th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To test the effectiveness of a telephone care management intervention to increase the use of primary and preventive care, reduce hospital admissions, and reduce emergency department visits for Medicaid beneficiaries with disabilities in a managed care setting. Data Source Four years (2007–2011) of Medicaid claims data on blind and/or disabled beneficiaries, aged 20–64. Study Design Randomized control trial with an intervention group (n = 3,540) that was enrolled in managed care with telephone care management and a control group (n = 1,524) who remained in fee-for-service system without care management services. Multi-disciplinary care coordination teams provided telephone services to the intervention group to address patients’ medical and social needs. Data Collection/Extraction Medicaid claims and encounter data for all participants were obtained from the state and the managed care organization
April 5th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010
April 5th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010
April 5th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To determine whether comprehensive behavioral health parity leads to changes in expenditures for individuals with severe mental illness (SMI), who are likely to be in greatest need for services that could be outside of health plans’ traditional limitations on behavioral health care. Data Sources/Study Setting We studied the effects of a comprehensive parity law enacted by Oregon in 2007. Using claims data, we compared expenditures for individuals in four Oregon commercial plans from 2005 through 2008 to a group of commercially insured individuals in Oregon who were exempt from parity. Study Design We used difference-in-differences and difference-in-difference-in-differences analyses to estimate changes in spending, and quantile regression methods to assess changes in the distribution of expenditures associated with parity. Principal Findings Among 2,195 individuals with SMI, parity was associated with increased expenditures for behavioral health services of $333 (95 percent CI $67, $615), without corresponding increases in out-of-pocket spending
April 5th, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To illustrate how the analysis of bimodal U-shaped distributed utilization can be modeled with beta-binomial regression, which is rarely used in health services research. Data Sources/Study Setting Veterans Affairs (VA) administrative data and Medicare claims in 2001–2004 for 11,123 Medicare-eligible VA primary care users in 2000. Study Design We compared means and distributions of VA reliance (the proportion of all VA/Medicare primary care visits occurring in VA) predicted from beta-binomial, binomial, and ordinary least-squares (OLS) models. Principal Findings Beta-binomial model fits the bimodal distribution of VA reliance better than binomial and OLS models due to the nondependence on normality and the greater flexibility in shape parameters. Conclusions Increased awareness of beta-binomial regression may help analysts apply appropriate methods to outcomes with bimodal or U-shaped distributions.
March 23rd, 2013 | Posted in Journal Watch | Read More »
By Health Services Research
Objective To evaluate the effect of Medicaid bed-hold policies on hospitalization of long-stay nursing home residents. Data Sources A nationwide random sample of long-stay nursing home residents with data elements from Medicare claims and enrollment files, the Minimum Data Set, the Online Survey Certification and Reporting System, and Area Resource File. The sample consisted of 22,200,089 person-quarters from 754,592 individuals who became long-stay residents in 17,149 nursing homes over the period beginning January 1, 2000 through December 31, 2005. Study Design Linear regression models using a pre/post design adjusted for resident, nursing home, market, and state characteristics. Nursing home and year-quarter fixed effects were included to control for time-invariant facility influences and temporal trends associated with hospitalization of long-stay residents.
March 23rd, 2013 | Posted in Journal Watch | Read More »
