1
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Reddy AT, Lee JP, Leiman DA. Measuring and improving quality in esophageal care and swallowing disorders. Dis Esophagus 2024; 37:doae013. [PMID: 38458618 DOI: 10.1093/dote/doae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/13/2024] [Indexed: 03/10/2024]
Abstract
Evaluating clinical care through quality-related metrics is increasingly common. There are now numerous quality statements and indicators related to the medical management of benign and pre-malignant esophageal diseases. Expert consensus leveraging evidence-based recommendations from published society guidelines has been the most frequently used basis for developing esophageal quality statements. While surgical care of patients with esophageal malignancies, including squamous cell carcinoma, has also been developed, those related to benign esophageal disease now include domains of diagnosis, treatment, and monitoring for gastroesophageal reflux disease, eosinophilic esophagitis (EoE), achalasia, and Barrett's esophagus (BE). Several recent studies evaluating adherence to quality metrics affirm substantial variation in practice patterns with opportunities for improvement in care across esophageal diseases. In particular, patient education regarding treatment options in achalasia, frequency of esophageal biopsies among patients with dysphagia to evaluate for EoE, and endoscopic evaluation within a BE segment are areas identified to have need for improvement. As the management of esophageal diseases becomes more complex and interdisciplinary, adherence to quality metrics may be a source of standardization and improvement in delivery and ultimately patient outcomes. Indeed, the development of national quality databases has resulted in a significant growth in the use of these metrics for quality improvement activities and may form the basis for future inclusion in quality reporting and payment programs.
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Affiliation(s)
| | - Joshua P Lee
- Division of Gastroenterology, Duke University, Durham, NC, USA
| | - David A Leiman
- Division of Gastroenterology, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
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Tsang CCS, Wang J. Addressing racial/ethnic disparities associated with Medicare Part D Star Ratings among population with Alzheimer's disease and related dementias. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1067-1075. [PMID: 37551695 PMCID: PMC10592311 DOI: 10.1080/14737167.2023.2245139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 08/01/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Previous studies noted that racial/ethnic minority groups were less likely than non-Hispanic White beneficiaries to be included in the assessment of medication utilization measures of Medicare Part D Star Ratings due to restrictive inclusion criteria for measure calculation. This study explored whether adding a measure with less stringent inclusion criteria to Star Ratings can reduce disparities in measure assessment among beneficiaries with Alzheimer's disease and related dementias (ADRD). METHODS This cross-sectional study utilized 2017 Medicare databases linked to Area Health Resources Files. Multivariable logistic regression was used to compare disparities before and after adding the new measure. RESULTS By adding the new measure, disparities in the odds for assessment inclusion between non-Hispanic White beneficiaries and Black, Hispanic, Asian, and Other beneficiaries were respectively reduced by 97% (odds ratio, or OR = 1.97, 95% Confidence Interval or CI = 1.89-2.05), 72% (OR = 1.72, 95% CI = 1.58-1.87), 115% (OR = 2.15, 95% CI = 1.87-2.46), and 44% (OR = 1.44, 95% CI = 1.28-1.62). CONCLUSIONS To improve the selection of medication utilization measures in Star Ratings among beneficiaries with ADRD, policymakers should investigate the optimal composition of measures to better align the interests of patients, providers, and health plans.
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Affiliation(s)
- Chi Chun Steve Tsang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, United States
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3
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Ryan AM, Gulseren B, Ayanian JZ, Markovitz AA, Meyers DJ, Brown EF. Association Between Double Bonuses and Clinical and Administrative Performance in Medicare Advantage. JAMA HEALTH FORUM 2022; 3:e223301. [PMID: 36218947 PMCID: PMC9508651 DOI: 10.1001/jamahealthforum.2022.3301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This cross-sectional study compares double bonuses with clinical and administrative performance in Medicare Advantage facilities.
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Affiliation(s)
- Andrew M. Ryan
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor,University of Michigan Center for Evaluating Health Reform, Ann Arbor
| | - Baris Gulseren
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor,University of Michigan Center for Evaluating Health Reform, Ann Arbor
| | - John Z. Ayanian
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor
| | - Adam A. Markovitz
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - David J. Meyers
- Department of Health Services, Policy & Practice, Brown School of Public Health, Providence, Rhode Island
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Fardousi N, Nunes da Silva E, Kovacs R, Borghi J, Barreto JOM, Kristensen SR, Sampaio J, Shimizu HE, Gomes LB, Russo LX, Gurgel GD, Powell-Jackson T. Performance bonuses and the quality of primary health care delivered by family health teams in Brazil: A difference-in-differences analysis. PLoS Med 2022; 19:e1004033. [PMID: 35797409 PMCID: PMC9262241 DOI: 10.1371/journal.pmed.1004033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pay-for-performance (P4P) programmes to incentivise health providers to improve quality of care have been widely implemented globally. Despite intuitive appeal, evidence on the effectiveness of P4P is mixed, potentially due to differences in how schemes are designed. We exploited municipality variation in the design features of Brazil's National Programme for Improving Primary Care Access and Quality (PMAQ) to examine whether performance bonuses given to family health team workers were associated with changes in the quality of care and whether the size of bonus mattered. METHODS AND FINDINGS For this quasi-experimental study, we used a difference-in-differences approach combined with matching. We compared changes over time in the quality of care delivered by family health teams between (bonus) municipalities that chose to use some or all of the PMAQ money to provide performance-related bonuses to team workers with (nonbonus) municipalities that invested the funds using traditional input-based budgets. The primary outcome was the PMAQ score, a quality of care index on a scale of 0 to 100, based on several hundred indicators (ranging from 598 to 660) of health care delivery. We did one-to-one matching of bonus municipalities to nonbonus municipalities based on baseline demographic and economic characteristics. On the matched sample, we used ordinary least squares regression to estimate the association of any bonus and size of bonus with the prepost change over time (between November 2011 and October 2015) in the PMAQ score. We performed subgroup analyses with respect to the local area income of the family health team. The matched analytical sample comprised 2,346 municipalities (1,173 nonbonus municipalities; 1,173 bonus municipalities), containing 10,275 family health teams that participated in PMAQ from the outset. Bonus municipalities were associated with a 4.6 (95% CI: 2.7 to 6.4; p < 0.001) percentage point increase in the PMAQ score compared with nonbonus municipalities. The association with quality of care increased with the size of bonus: the largest bonus group saw an improvement of 8.2 percentage points (95% CI: 6.2 to 10.2; p < 0.001) compared with the control. The subgroup analysis showed that the observed improvement in performance was most pronounced in the poorest two-fifths of localities. The limitations of the study include the potential for bias from unmeasured time-varying confounding and the fact that the PMAQ score has not been validated as a measure of quality of care. CONCLUSIONS Performance bonuses to family health team workers compared with traditional input-based budgets were associated with an improvement in the quality of care.
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Affiliation(s)
- Nasser Fardousi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Roxanne Kovacs
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Juliana Sampaio
- Department of Health Promotion, Federal University of Paraiba, João Pessoa, Paraiba, Brazil
| | | | - Luciano B. Gomes
- Department of Health Promotion, Federal University of Paraiba, João Pessoa, Paraiba, Brazil
| | | | | | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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Markovitz AA, Ayanian JZ, Sukul D, Ryan AM. The Medicare Advantage Quality Bonus Program Has Not Improved Plan Quality. Health Aff (Millwood) 2021; 40:1918-1925. [PMID: 34871083 DOI: 10.1377/hlthaff.2021.00606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2012 Medicare introduced the quality bonus program, linking financial bonuses to commercial insurers' quality performance in Medicare Advantage (MA). Despite large investments in the program, evidence of its effectiveness is limited. We analyzed insurance claims from the period 2009-2018 from the nation's largest MA claims database for 3,753,117 MA beneficiaries (treatment group) and 4,025,179 commercial enrollees (control group). Using a difference-in-differences framework, we evaluated changes in performance on nine claims-based measures of quality in both groups before and after the start of the bonus program and with adjustment for differential pre-period trends. We observed no consistent differential improvement in quality for MA versus commercial enrollees under the quality bonus program. Program participation was associated with significant quality improvements among MA beneficiaries on four measures, significant declines on four other measures, and no significant change in overall quality performance (+0.6 percentage points). Together, these results suggest that the quality bonus program did not produce the intended improvement in overall quality performance of MA plans.
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Affiliation(s)
- Adam A Markovitz
- Adam A. Markovitz is a resident in the Department of Internal Medicine, University of Michigan Medical School, and a research fellow in the Department of Health Management and Policy, University of Michigan School of Public Health, both in Ann Arbor, Michigan
| | - John Z Ayanian
- John Z. Ayanian is the Alice Hamilton Collegiate Professor of Medicine in the Department of Internal Medicine, University of Michigan Medical School, and director of the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Devraj Sukul
- Devraj Sukul is a clinical lecturer in internal medicine, University of Michigan Medical School
| | - Andrew M Ryan
- Andrew M. Ryan is the UnitedHealthcare Professor of Health Care Management, Department of Health Management and Policy, University of Michigan School of Public Health, and director of the Center for Evaluating Health Reform, University of Michigan
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Meyers DJ, Rahman M, Wilson IB, Mor V, Trivedi AN. The Relationship Between Medicare Advantage Star Ratings and Enrollee Experience. J Gen Intern Med 2021; 36:3704-3710. [PMID: 33846937 PMCID: PMC8642571 DOI: 10.1007/s11606-021-06764-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Medicare Advantage plans, private managed care plans that enrolled 34% of Medicare beneficiaries in 2019, received $6 billion in annual bonus payments on the basis of their performance on a 5-star rating system. Little is known, however, as to the extent these ratings adequately capture enrollee experience. OBJECTIVES To measure the effect of exposure to higher rated Medicare Advantage contracts on enrollee experience. DESIGN An instrumental variables analysis using MA contract consolidation as an exogenous shock to the quality of plan enrollees are exposed to. PARTICIPANTS A total of 345,897 MA enrollees enrolled in non-consolidated contracts and 21,405 enrollees who were consolidated. MAIN MEASURES The primary exposure was enrollee star rating, instrumented using contract consolidation. The primary outcomes were enrollee self-reported experience measures. KEY RESULTS There were no significant effects on increased star ratings on 23 of 27 outcomes. A one-star increase in contract star rating leads to a 5.4 percentage point increase in reporting that pain does not interfere with daily activities (95%CI 2.4, 8.4), and a 4.4 percentage reduction in the likelihood that a physician would talk to the enrollee about physical activity (95%CI: -7.8, -1.1, all p<0.05). A one-star increase in contract star rating led to an 8.4 percentage point reduction in achieving the top score on the received needed information index (95%CI: -16.4, -0.4), and a 1.8 percentage point reduction in responding with the lowest score for the overall rating of care (95%CI: -3.5, -0.1). CONCLUSIONS Exposure to a higher rated MA contract did not appreciably increase enrollee experience. Policymakers should consider reassessing how these ratings and associated bonus payments are currently calculated.
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Affiliation(s)
- David J Meyers
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
| | - Momotazur Rahman
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Ira B Wilson
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
| | - Vincent Mor
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Providence VA Medical Center, Providence, RI, USA
| | - Amal N Trivedi
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA
- Providence VA Medical Center, Providence, RI, USA
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Markovitz AA, Ayanian JZ, Warrier A, Ryan AM. Medicare Advantage Plan Double Bonuses Drive Racial Disparity In Payments, Yield No Quality Or Enrollment Improvements. Health Aff (Millwood) 2021; 40:1411-1419. [PMID: 34495734 DOI: 10.1377/hlthaff.2021.00349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Under the Medicare Advantage (MA) quality bonus payment program, initiated in 2012, MA plans with relatively high quality performance that are located in "double bonus"-eligible counties-metropolitan areas with high MA enrollment and low fee-for-service Medicare spending-receive quality bonuses twice as large as those received by equivalently high-quality plans in double-bonus-ineligible counties. Using national data for 2008-18, we found that double bonuses were not associated with either improvements in plan quality or increased MA enrollment. Additionally, because Black beneficiaries were less likely to reside in eligible counties, double bonuses increased payments to plans to care for Black beneficiaries by $60 per year, compared with $91 for White beneficiaries. Our findings suggest that double bonuses not only fail to improve quality and enrollment but also foster a racially inequitable distribution of Medicare funds that disfavors Black beneficiaries. Our study supports eliminating double bonuses, thereby saving Medicare an estimated $1.8 billion per year.
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Affiliation(s)
- Adam A Markovitz
- Adam A. Markovitz is an internal medicine resident at the University of Michigan, in Ann Arbor, Michigan
| | - John Z Ayanian
- John Z. Ayanian is the Alice Hamilton Collegiate Professor of Medicine in the Department of Internal Medicine, University of Michigan Medical School, and director of the Institute for Healthcare Policy and Innovation, University of Michigan
| | - Anupama Warrier
- Anupama Warrier is a PhD student in the Department of Health Management and Policy, University of Michigan School of Public Health
| | - Andrew M Ryan
- Andrew M. Ryan is the UnitedHealthcare Professor of Health Care Management, Department of Health Management and Policy, University of Michigan School of Public Health, and director of the Center for Evaluating Health Reform, University of Michigan
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Meyers DJ, Trivedi AN, Wilson IB, Mor V, Rahman M. Higher Medicare Advantage Star Ratings Are Associated With Improvements In Patient Outcomes. Health Aff (Millwood) 2021; 40:243-250. [PMID: 33523734 PMCID: PMC7899034 DOI: 10.1377/hlthaff.2020.00845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Little is known about how well the Centers for Medicare and Medicaid Services' five-star rating system for the overall quality of Medicare Advantage (MA) contracts captures quality of care. Leveraging contract consolidation as a natural experiment to study the association between outcomes and insurer-initiated enrollee shifts to plans with higher-rated contracts, we found that enrollees experiencing a one-star MA rating increase were 20.8 percent less likely to voluntarily leave their plan to enroll in another plan or traditional Medicare. When hospitalized, they were 3.4 percent more likely to use a higher-quality hospital and 2.6 percent less likely to be readmitted within ninety days. Our findings suggest that MA star ratings may capture key domains of an MA plan's quality; however, the differences in outcomes that they capture might not all be clinically meaningful.
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Affiliation(s)
- David J Meyers
- David J. Meyers is an assistant professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health, in Providence, Rhode Island
| | - Amal N Trivedi
- Amal N. Trivedi is a professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health and a research health scientist at the Providence Veterans Affairs (VA) Medical Center, both in Providence
| | - Ira B Wilson
- Ira B. Wilson is a professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health
| | - Vincent Mor
- Vincent Mor is a professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health and a research health scientist at the Providence VA Medical Center
| | - Momotazur Rahman
- Momotazur Rahman is an associate professor in the Department of Health Services, Policy, and Practice at the Brown University School of Public Health
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Agniel D, Haviland A, Shekelle P, Scherling A, Damberg CL. Distinguishing High-Performing Health Systems Using a Composite of Publicly Reported Measures of Ambulatory Care. Ann Intern Med 2020; 173:791-798. [PMID: 32956603 DOI: 10.7326/m20-0718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Payers and policymakers are rewarding high-performing health care providers on the basis of summaries of overall quality performance, and the methods they use for measuring performance are increasingly important. OBJECTIVE To develop and evaluate a measure that ranks health care systems by ambulatory care quality. DESIGN Systems were ranked using a composite model that summarizes individual measures of quality, accounts for their correlation, and does not require health care systems to report every measure. The composite measure's suitability was evaluated by examining whether it captured the quality indicated by component measures (validity), whether differences in rank between health care systems were larger than statistical noise (reliability), and whether year-to-year changes in rank were small (stability). SETTING California and Minnesota, 2014 to 2016. PARTICIPANTS 55 health care systems. MEASUREMENTS Publicly reported measures of ambulatory care quality. RESULTS The composite measure was valid in that it was broadly representative of the component measures and was not dominated by any single measure. The measure was reliable because the ranks for 93% of California systems and 80% of Minnesota systems were unlikely to be more than 2 places lower or higher. The measure was stable because fewer than half of systems changed ranks by more than 2 ranks from year to year. LIMITATION The analysis is limited to available measures of ambulatory care quality and includes only 2 states. CONCLUSION This composite measure uses publicly reported data to produce valid, reliable, and stable ranks of ambulatory care quality for health care systems in Minnesota and California, and this approach could be used in other applications. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Denis Agniel
- RAND Corporation, Santa Monica, California, and Harvard Medical School, Boston, Massachusetts (D.A.)
| | | | - Paul Shekelle
- RAND Corporation, Santa Monica, and West Los Angeles Veterans Affairs Medical Center, Los Angeles, California (P.S.)
| | - Adam Scherling
- RAND Corporation, Santa Monica, California (A.S., C.L.D.)
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Decarolis F, Guglielmo A, Luscombe C. Open enrollment periods and plan choices. HEALTH ECONOMICS 2020; 29:733-747. [PMID: 32100363 DOI: 10.1002/hec.4014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 12/23/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
Open enrollment periods are pervasively used in insurance markets to limit adverse selection risks resulting when enrollees can switch plans at will. We exploit a change in the open enrollment rules of Medicare Advantage to analyze how beneficiaries responded to the option of switching to a 5-star-rated plan at anytime, in a setting where insurers adjusted premiums and benefit design to counterbalance the increased selection risk. We present three findings: Within-year switches to 5-star plans increase by 7-16%; demand for 5-star plans across the years does not decline; and the enrollees who switch to a 5-star plan during the year are in better health status than those who do not switch.
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Politics and Policymaking in Medicare Part C. Med Care 2020; 58:285-292. [PMID: 31789690 DOI: 10.1097/mlr.0000000000001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Once just a small part of the Medicare program, private managed care plans now cover over one-third of all Medicare beneficiaries and cost the Federal government ~$210 billion each year. Importantly, the evolution of Medicare managed care policy has been far from linear; for several decades there have been dramatic shifts in the payment and regulatory policies facing private Medicare managed care plans. OBJECTIVES This article presents a critical review of the history of Medicare managed care payment and regulatory policies and discusses the role of political ideology and stakeholder influence in shaping the direction of policy over time. CONCLUSIONS As Medicare Advantage becomes an increasingly prominent area of focus for the health services, health policy, and medical research communities, it is important to bear in mind the highly political history of the program, the role of stakeholder influence in shaping the direction of policy, and to understand the historic barriers to evidence-based policymaking.
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O'Neill S, Kreif N, Sutton M, Grieve R. A comparison of methods for health policy evaluation with controlled pre-post designs. Health Serv Res 2020; 55:328-338. [PMID: 32052455 PMCID: PMC7080394 DOI: 10.1111/1475-6773.13274] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To compare interactive fixed effects (IFE) and generalized synthetic control (GSC) methods to methods prevalent in health policy evaluation and re‐evaluate the impact of the hip fracture best practice tariffs introduced for hospitals in England in 2010. Data Sources Simulations and Hospital Episode Statistics. Study Design Best practice tariffs aimed to incentivize providers to deliver care in line with guidelines. Under the scheme, 62 providers received an additional payment for each hip fracture admission, while 49 providers did not. We estimate the impact using difference‐in‐differences (DiD), synthetic control (SC), IFE, and GSC methods. We contrast the estimation methods' performance in a Monte Carlo simulation study. Principal Findings Unlike DiD, SC, and IFE methods, the GSC method provided reliable estimates across a range of simulation scenarios and was preferred for this case study. The introduction of best practice tariffs led to a 5.9 (confidence interval: 2.0 to 9.9) percentage point increase in the proportion of patients having surgery within 48 hours and a statistically insignificant 0.6 (confidence interval: −1.4 to 0.4) percentage point reduction in 30‐day mortality. Conclusions The GSC approach is an attractive method for health policy evaluation. We cannot be confident that best practice tariffs were effective.
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Affiliation(s)
- Stephen O'Neill
- J.E. Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland.,Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Noemi Kreif
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Health Economics, University of York, York, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK.,Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Ahluwalia SC, Damberg CL, Haas A, Shekelle PG. How are medical groups identified as high-performing? The effect of different approaches to classification of performance. BMC Health Serv Res 2019; 19:500. [PMID: 31319830 PMCID: PMC6639957 DOI: 10.1186/s12913-019-4293-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/23/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Payers and policy makers across the international healthcare market are increasingly using publicly available summary measures to designate providers as "high-performing", but no consistently-applied approach exists to identifying high performers. This paper uses publicly available data to examine how different classification approaches influence which providers are designated as "high-performers". METHODS We conducted a quantitative analysis of cross-sectional publicly-available performance data in the U.S. We used 2014 Minnesota Community Measurement data from 58 medical groups to classify performance across 4 domains: quality (two process measures of cancer screening and 2 composite measures of chronic disease management), total cost of care, access (a composite CAHPS measure), and patient experience (3 CAHPS measures). We classified medical groups based on performance using either relative thresholds or absolute values of performance on all included measures. RESULTS Using relative thresholds, none of the 58 medical groups achieved performance in the top 25% or 35% in all 4 performance domains. A relative threshold of 40% was needed before one group was classified as high-performing in all 4 domains. Using absolute threshold values, two medical groups were classified as high-performing across all 4 domains. In both approaches, designating "high performance" using fewer domains led to more groups designated as high-performers, though there was little to moderate concordance across identified "high-performing" groups. CONCLUSIONS Classification of medical groups as high performing is sensitive to the domains of performance included, the classification approach, and choice of threshold. With increasing focus on achieving high performance in healthcare delivery, the absence of a consistently-applied approach to identify high performers impedes efforts to reliably compare, select and reward high-performing providers.
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Affiliation(s)
- Sangeeta C. Ahluwalia
- RAND Corporation, 1776 Main Street, Santa Monica, CA 91403 USA
- UCLA Fielding School of Public Health, Los Angeles, CA USA
| | | | - Ann Haas
- RAND Corporation, Pittsburgh, PA USA
| | - Paul G. Shekelle
- RAND Corporation, 1776 Main Street, Santa Monica, CA 91403 USA
- VA West Los Angeles Medical Center, Los Angeles, CA USA
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McGarry BE, Layton TJ, Grabowski DC. The effects of plan payment rates on the market for Medicare Advantage Dual-Eligible Special Needs Plans. Health Serv Res 2019; 54:1137-1145. [PMID: 31111471 DOI: 10.1111/1475-6773.13170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the effect of higher potential benchmark payment rates on the market for Medicare Advantage (MA) Dual-Eligible Special Needs Plans (D-SNPs). DATA SOURCES/STUDY SETTING Publicly available county-level data from 2009 to 2015 regarding the number of D-SNPs operating within the county, the enrollment in and five-star quality of score of these plans, and the benchmark amounts used to determine capitated plan payments. STUDY DESIGN This study exploits the introduction of quality bonus payments to the MA program in 2012, and exogenous geographic variation in the potential size of these bonuses to estimate the effect of benchmark payment increases on the availability, quality, and take-up of D-SNPs. We use a difference-in-difference estimation approach to compare changes in the market for D-SNPs in counties eligible for a double bonus to those that are not. PRINCIPAL FINDINGS The doubling of bonuses was associated with a relative 29 percent increase in the number of D-SNPs offered (P = 0.021) and 0.1-star increase in the average quality of available D-SNPs (P = 0.034). No relative increase in overall D-SNP enrollment was detected. CONCLUSIONS These findings indicate that larger benchmark payment amounts may influence insurers' decisions of whether to participate in the D-SNP market but not dual-eligibles' decision of whether to enroll in these plans. Future research is needed to inform discussions about whether D-SNPs are a viable mechanism for integrating benefits for dual eligibles and the degree to which Medicare policies should support their continued growth.
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Affiliation(s)
- Brian E McGarry
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Timothy J Layton
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Kim H, Charlesworth CJ, McConnell KJ, Valentine JB, Grabowski DC. Comparing Care for Dual-Eligibles Across Coverage Models: Empirical Evidence From Oregon. Med Care Res Rev 2017; 76:661-677. [PMID: 29139330 DOI: 10.1177/1077558717740206] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dual-eligible beneficiaries or "duals" are individuals enrolled in both the Medicare and Medicaid programs. For both Medicare and Medicaid, they may be enrolled in fee-for-service or managed care, creating a mix of possible coverage models. Understanding these different models is essential to improving care for duals. Using All-Payer All-Claims data, we empirically described health service use and quality of care for Oregon duals across five coverage models with different combinations of fee-for-service, managed care, and plan alignment status across Medicare and Medicaid. We found substantial heterogeneity in care across these five coverage models. We also found that duals in plans with aligned financial incentives for Medicare and Medicaid experienced more improvement in their care relative to those with nonaligned Medicare Advantage and Medicaid managed care plans. These results highlight the importance of developing policies that account for the heterogeneity of the dual population and their coverage options.
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Affiliation(s)
- Hyunjee Kim
- 1 Oregon Health and Science University, Portland, OR, USA
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Ödesjö H, Anell A, Boman A, Fastbom J, Franzén S, Thorn J, Björck S. Pay for performance associated with increased volume of medication reviews but not with less inappropriate use of medications among the elderly - an observational study. Scand J Prim Health Care 2017; 35:271-278. [PMID: 28830291 PMCID: PMC5592354 DOI: 10.1080/02813432.2017.1358434] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted. We assessed the association with inappropriate medication for five years after baseline. DESIGN AND SETTING Observational study that compared medication for elderly patients enrolled at primary care units that coded for a high or low volume of medication reviews. PATIENTS 144,222 individuals at 196 primary care centres, age 75 or older. MAIN OUTCOME MEASURES Percentage of patients receiving inappropriate drugs or polypharmacy during five years at primary care units with various levels of reported medication reviews. RESULTS The proportion of patients with a registered medication review had increased from 3.2% to 44.1% after five years. The high-coding units performed better for most indicators but had already done so at baseline. Primary care units with the lowest payment for coding for medication reviews improved just as well in terms of inappropriate drugs as units with the highest payment - from 13.0 to 8.5%, compared to 11.6 to 7.4% and from 13.6 to 7.2% vs 11.8 to 6.5% for polypharmacy. CONCLUSIONS Payment linked to coding for medication reviews was associated with an increase in the percentage of patients for whom a medication review had been registered. However, the impact of payment on quality improvement is uncertain, given that units with the lowest payment for medication reviews improved equally well as units with the highest payment.
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Affiliation(s)
- H. Ödesjö
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
- CONTACT Helena Ödesjö Primary Health Care, Region Västra Götaland, Närhälsan Torslanda Vårdcentral, Nordhagsvägen 2A, SE-423 34 Torslanda, Sweden
| | - A. Anell
- Lund University School of Economics and Management, Lund, Sweden
| | - A. Boman
- Department of Economics, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
| | - J. Fastbom
- Aging Research Centre, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - S. Franzén
- Centre of Registers, Region Västra Götaland, Gothenburg, Sweden
| | - J. Thorn
- Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - S. Björck
- Centre of Registers, Region Västra Götaland, Gothenburg, Sweden
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17
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Bash LD, Weitzman D, Blaustein RO, Sharon O, Shalev V, Chodick G. Comprehensive healthcare resource use among newly diagnosed congestive heart failure. Isr J Health Policy Res 2017; 6:26. [PMID: 28593038 PMCID: PMC5458478 DOI: 10.1186/s13584-017-0149-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/01/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Congestive heart failure (CHF) is among the most common causes of hospital admissions and readmissions in the Western world. However, the burden of ambulatory care has not been as well investigated. The objective of this study was to assess the relative burden and direct medical costs of CHF including inpatient and outpatient care. METHODS We used longitudinal clinical data from a two-million member health organization in Israel (Maccabi Healthcare Services) to identify adults with newly diagnosed CHF between January 2006 and December 2012, either in the in- or outpatient setting. Adults without CHF were age- and sex-matched to CHF patients and healthcare utilization and all modes of healthcare costs were compared among them, excluding those in their last year of life. RESULTS The burden posed by 6592 CHF patients was significantly (p < 0.001) larger than that of 32,960 matched controls. CHF patients had significantly higher rates of baseline comorbidity and healthcare utilization compared to non-CHF controls. This was evident in all categories of healthcare services and expenses, including in- and outpatient visits, laboratory expenses, medication costs, among younger and older, men and women. Among those who incurred any healthcare costs, younger (45-64y) and older (65 + y) subjects with CHF were observed to have about 3.25 (95% CI: 2.96-3.56) and 2.08 (95% CI: 1.99-2.17) times the healthcare costs, respectively, compared to subjects without CHF after adjusting for patient characteristics. CONCLUSION CHF is associated with an overall two- to three-fold higher cost of healthcare services depending on patient age, accounting for over half of all healthcare costs incurred by elderly CHF patients, and more than two-thirds of all costs among younger CHF patients. Observations of the large burden posed on one of the youngest societies in the developed world are profound, implicative of great opportunities to control the costs of CHF. Further research to understand how resource use impacts health outcomes and quality of care is warranted.
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Affiliation(s)
| | - Dahlia Weitzman
- Maccabitech, Maccabi Healthcare Services, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - Varda Shalev
- Maccabitech, Maccabi Healthcare Services, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gabriel Chodick
- Maccabitech, Maccabi Healthcare Services, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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18
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Grytten J. Payment systems and incentives in dentistry. Community Dent Oral Epidemiol 2016; 45:1-11. [DOI: 10.1111/cdoe.12267] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jostein Grytten
- Department of Community Dentistry; University of Oslo; Oslo Norway
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Bogner HR, de Vries McClintock HF, Kurichi JE, Kwong PL, Xie D, Hennessy S, Streim JE, Stineman MG. Patient Satisfaction and Prognosis for Functional Improvement and Deterioration, Institutionalization, and Death Among Medicare Beneficiaries Over 2 Years. Arch Phys Med Rehabil 2016; 98:1-10. [PMID: 27590442 DOI: 10.1016/j.apmr.2016.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults. DESIGN National representative sample with 2-year follow-up. SETTING Medicare Current Beneficiary Survey from calendar years 2001 to 2008. PARTICIPANTS Community-dwelling adults (N=23,470) aged ≥65 years followed for 2 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activities of daily living (ADL) stage transitions, institutionalization, or death after 2 years, adjusting for baseline socioeconomics and health-related characteristics. RESULTS Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio [RRR], .68; 95% confidence interval [CI], .54-.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI, .79-.97), be institutionalized (adjusted RRR, .72; 95% CI, .56-.92), or die (adjusted RRR, .86; 95% CI, .75-.98). CONCLUSIONS Knowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related health care disparities and the effect of ongoing policy changes among Medicare beneficiaries.
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Affiliation(s)
- Hillary R Bogner
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Heather F de Vries McClintock
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jibby E Kurichi
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Pui L Kwong
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Dawei Xie
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sean Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel E Streim
- Geriatric Psychiatry Section of the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Margaret G Stineman
- Department of Physical Medicine and Rehabilitation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Ryan AM, Tompkins CP, Markovitz AA, Burstin HR. Linking Spending and Quality Indicators to Measure Value and Efficiency in Health Care. Med Care Res Rev 2016; 74:452-485. [DOI: 10.1177/1077558716650089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Policy makers and stakeholders have reached a consensus that both quality and spending or resource use indicators should be jointly measured and prioritized to meet the objectives of our health system. However, the relative merits of alternative approaches that combine quality and spending indicators are not well understood. We conducted a literature review to identify different approaches that combine indicators of quality and spending measures to profile provider efficiency in the context of specific applications in health care. Our investigation identified seven alternative models that are either in use or have been proposed to evaluate provider efficiency. We then used publicly available data to profile hospitals using these approaches. Profiles of hospital efficiency using alternative models yielded wide variation in performance, underscoring the importance of model selection. By identifying the current efficiency models and evaluating their trade-offs within specific programmatic contexts, our analysis informs stakeholder and policy maker decisions about how to link quality and spending indicators when measuring efficiency in health care.
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Affiliation(s)
- Andrew M. Ryan
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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21
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Li P, Doshi JA. Impact of Medicare Advantage Prescription Drug Plan Star Ratings on Enrollment before and after Implementation of Quality-Related Bonus Payments in 2012. PLoS One 2016; 11:e0154357. [PMID: 27149092 PMCID: PMC4858248 DOI: 10.1371/journal.pone.0154357] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 04/12/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Since 2007, the Centers for Medicare and Medicaid Services have published 5-star quality rating measures to aid consumers in choosing Medicare Advantage Prescription Drug Plans (MAPDs). We examined the impact of these star ratings on Medicare Advantage Prescription Drug (MAPD) enrollment before and after 2012, when star ratings became tied to bonus payments for MAPDs that could be used to improve plan benefits and/or reduce premiums in the subsequent year. METHODS A longitudinal design and multivariable hybrid models were used to assess whether star ratings had a direct impact on concurrent year MAPD contract enrollment (by influencing beneficiary choice) and/or an indirect impact on subsequent year MAPD contract enrollment (because ratings were linked to bonus payments). The main analysis was based on contract-year level data from 2009-2015. We compared effects of star ratings in the pre-bonus payment period (2009-2011) and post-bonus payment period (2012-2015). Extensive sensitivity analyses varied the analytic techniques, unit of analysis, and sample inclusion criteria. Similar analyses were conducted separately using stand-alone PDP contract-year data; since PDPs were not eligible for bonus payments, they served as an external comparison group. RESULT The main analysis included 3,866 MAPD contract-years. A change of star rating had no statistically significant effect on concurrent year enrollment in any of the pre-, post-, or pre-post combined periods. On the other hand, star rating increase was associated with a statistically significant increase in the subsequent year enrollment (a 1-star increase associated with +11,337 enrollees, p<0.001) in the post-bonus payment period but had a very small and statistically non-significant effect on subsequent year enrollment in the pre-bonus payment period. Further, the difference in effects on subsequent year enrollment was statistically significant between the pre- and post-periods (p = 0.011). Sensitivity analyses indicated that the findings were robust. No statistically significant effect of star ratings was found on concurrent or subsequent year enrollment in the pre- or post-period in the external comparison group of stand-alone PDP contracts. CONCLUSION Star ratings had no direct impact on concurrent year MAPD enrollment before or after the introduction of bonus payments tied to star ratings. However, after the introduction of these bonus payments, MAPD star ratings had a significant indirect impact of increasing subsequent year enrollment, likely via the reinvestment of bonuses to provide lower premiums and/or additional member benefits in the following year.
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Affiliation(s)
- Pengxiang Li
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
- * E-mail:
| | - Jalpa A. Doshi
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America
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Educating Pharmacists in Quality (EPIQ): Recipient, Academy for Healthcare Improvement 2015 Duncan Neuhauser Award for Curricular Innovation. Qual Manag Health Care 2016; 25:61-5. [PMID: 26783869 DOI: 10.1097/qmh.0000000000000082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Duncan Neuhauser Award for curriculum Innovation is presented annually at the Academy for Healthcare Improvement meeting. The award recognizes education providers that show innovation and improvement in advancing skills in health care. Duncan B. Neuhauser, PhD, a Senior Editor with the Quality Management in Health Care journal is a Professor of Health Services Research and the Charles Elton Blanchard Professor of Health Management at Case Western Reserve University. Dr Neuhauser has devoted his working life to the science of the improvement of health care and has served as a pioneer in the development of curriculum to promote health care improvement. The 2015 first place recipient was Educating Pharmacists in Quality (EPIQ) developed by the Pharmacy Quality Alliance. EPIQ was developed as a quality improvement education resource for use by pharmacy faculty and other professionals to teach students pharmacists, pharmacists, and other stakeholders about measuring, reporting, and improving quality in pharmacy practice. EPIQ has been integrated into more than 20 doctor of pharmacy curricula and has been used as part of employee training programs. Students and faculty members who have used the program have indicated via surveys that the program has a positive impact on awareness and knowledge of quality improvement in pharmacy.
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23
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Romano PS, Zinn JS. Best of the 2015 AcademyHealth Annual Research Meeting. Health Serv Res 2016; 50:1731-3. [PMID: 26768956 DOI: 10.1111/1475-6773.12421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Patrick S Romano
- UC Davis School of Medicine, Center for Healthcare Policy and Research, Sacramento, CA
| | - Jacqueline S Zinn
- Department of Risk, Insurance and Healthcare Management, Temple University, Philadelphia, PA
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