1
|
Stöber A, Marijic P, Kurz C, Schwarzkopf L, Kirsch F, Schramm A, Leidl R. Does uptake of specialty care affect HRQoL development in COPD patients beneficially? A difference-in-difference analysis linking claims and survey data. Eur J Health Econ 2023; 24:1561-1573. [PMID: 36637677 PMCID: PMC10550862 DOI: 10.1007/s10198-022-01562-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There is an evidence gap on whether the choice of specialty care beneficially affects health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD). This study analyzes how newly initiated pulmonologist care affects the generic and disease-specific HRQoL in COPD patients over a period of 1 year. METHODS We linked claims data with data from two survey waves to investigate the longitudinal effect of specialty care on HRQoL using linear Difference-in-Difference models based on 1:3 propensity score matched data. Generic HRQoL was operationalized by EQ-5D-5L visual analog scale (VAS), and disease-specific HRQoL by COPD assessment test (CAT). Subgroup analyses examined COPD patients with low (GOLD AB) and high (GOLD CD) exacerbation risk. RESULTS In contrast to routine care patients, pulmonologists' patients (n = 442) experienced no significant deterioration in HRQoL (VAS - 0.0, p = 0.9870; CAT + 0.5, p = 0.0804). Models unveiled a small comparative advantage of specialty care on HRQoL (mean change: CAT - 0.8, VAS + 2.9), which was especially pronounced for GOLD AB (CAT - 0.7; VAS + 3.1). CONCLUSION The uptake of pulmonologist care had a statistically significant, but not clinically relevant, beneficial impact on the development of HRQoL by slowing down overall HRQoL deterioration within 1 year. Including specialty care more appropriately in COPD management, especially at lower disease stages (GOLD AB), could thus improve patients' health outcome.
Collapse
Affiliation(s)
- Alisa Stöber
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany.
- Pettenkoffer School of Public Health, Munich, Germany.
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany.
| | - Pavo Marijic
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Christoph Kurz
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - Larissa Schwarzkopf
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Pettenkoffer School of Public Health, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Institut Fuer Therapieforschung (IFT), Working Group Therapy and Health Services Research, Munich, Germany
| | - Florian Kirsch
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Anja Schramm
- Service Center of Health Care Management, AOK Bayern, Regensburg, Germany
| | - Reiner Leidl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Munich, Germany
- Munich Center of Health Sciences (MC-Health), Institute for Health Economics and Management, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| |
Collapse
|
2
|
Lambrecht J, Abir M, Seiler K, Kamdar N, Peterson T, Lin P, Nham W, Greenwood-Ericksen M. Conceptualizing lifer versus destination patients for optimized care delivery. BMC Health Serv Res 2023; 23:1190. [PMID: 37915060 PMCID: PMC10619315 DOI: 10.1186/s12913-023-10214-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Patients presenting to academic medical centers (AMC) typically receive primary care, specialty care, or both. Resources needed for each type of care vary, requiring different levels of care coordination. We propose a novel method to determine whether a patient primarily receives primary or specialty care to allow for optimization of care coordination. OBJECTIVES We aimed to define the concepts of a Lifer Patient and Destination Patient and analyze the current state of care utilization in those groups to inform opportunities for improving care coordination. METHODS Using AMC data for a 36-month study period (FY17-19), we evaluated the number of unique patients by residence zip code. Patients with at least one primary care visit and patients without a primary care visit were classified as Lifer and Destination patients, respectively. Cohen's effect sizes were used to evaluate differences in mean utilization of different care delivery settings. RESULTS The AMC saw 35,909 Lifer patients and 744,037 Destination patients during the study period. Most patients were white, non-Hispanic females; however, the average age of a Lifer was seventy-two years whereas that of a Destination patient was thirty-eight. On average, a Lifer had three times more ambulatory care visits than a Destination patient. The proportion of Inpatient encounters is similar between the groups. Mean Inpatient length of stay (LOS) is similar between the groups, but Destination patients have more variance in LOS. The rate of admission from the emergency department (ED) for Destination patients is nearly double Lifers'. CONCLUSION There were differences in ED, ambulatory care, and inpatient utilization between the Lifer and Destination patients. Furthermore, there were incongruities between rate of hospital admissions and LOS between two groups. The Lifer and Destination patient definitions allow for identification of opportunities to tailor care coordination to these unique groups and to allocate resources more efficiently.
Collapse
Affiliation(s)
- Jacob Lambrecht
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Mahshid Abir
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
- RAND Corporation, Santa Monica, CA, USA.
| | - Kristian Seiler
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Neil Kamdar
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Tim Peterson
- Department of Emergency Medicine, University of Michigan, TC B1-220 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul Lin
- Data and Methods Hub, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine Research, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Greenwood-Ericksen
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
3
|
Vimalananda VG, Wormwood JB, Sitter KE, Fincke BG, Qian S, Tait MN, Meterko M. Adaptations for remote research work: a modified web-push strategy compared to a mail-only strategy for administering a survey of healthcare experiences. BMC Med Res Methodol 2023; 23:244. [PMID: 37858034 PMCID: PMC10588167 DOI: 10.1186/s12874-023-02066-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic required that our research team change our mail-only (MO) strategy for a research survey to a strategy more manageable by staff working remotely. We used a modified web-push approach (MWP), in which patients were mailed a request to respond online and invited to call if they preferred the questionnaire by mail or phone. We also changed from a pre-completion gift to a post-completion gift card incentive. Our objective is to compare response patterns between modes for a survey that used an MO strategy pre-pandemic followed by an MWP strategy peri-pandemic for data collection. METHODS Observational study using data from a national multi-scale survey about patients' experience of specialty care coordination administered via MO in 2019 and MWP from 2020 to 2021 to Veterans receiving primary care and specialty care within the Veterans Health Administration (VA). We compared response rates, respondent characteristics and responses about care coordination between MO and MWP, applying propensity weights to account for differences in the underlying samples. RESULTS The response rate was lower for MWP vs. MO (13.4% vs. 36.6%), OR = 0.27, 95% CI = 0.25-0.30, P < .001). Respondent characteristics were similar across MO and MWP. Coordination scale scores tended to be slightly higher for MWP, but the effect sizes for these differences between modes were small for 9 out of 10 scales. CONCLUSIONS While the logistics of MWP survey data collection are well-suited to the remote research work environment, response rates were lower than those for the MO method. Future studies should examine addition of multi-mode contacts and/or pre-completion incentives to increase response rates for MWP.
Collapse
Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA.
- Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, MA, USA.
| | - Jolie B Wormwood
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Kailyn E Sitter
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Shirley Qian
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, 200 Springs Road, Building 70, Bedford, MA, 01730, USA
| | - Maya N Tait
- International School of Boston, Cambridge, MA, USA
| | - Mark Meterko
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
- Analytics and Performance Integration, Office of Quality and Patient Safety, Department of Veterans Affairs, Bedford, MA, USA
| |
Collapse
|
4
|
de Fontgalland C, Lecourieux S, Ménoret F, Bidaut P, Rouzaud-Cornabas M, Rogez R. Accessing specialty consultations and procedures in Centre-Val de Loire region. Sante Publique 2023; 35:235-250. [PMID: 37848371 DOI: 10.3917/spub.233.0235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Introduction In the Centre-Val de Loire region, the demography of specialty care is characterized by a strong deficit and many territorial inequalities that lead to significant difficulties in accessing care. The study has being conducted at the level of the Professional Territorial Health Communities (CPTS) which structuring the region, which is the ideal framework for implementing public health actions resulting from this study. Purpose of research The aim of this study was to objectify these difficulties and their geography, based on the calculation of the comparative consumption index (CCI), in order to measure the differences between expected consumption and observed consumption, and to quantify the number of “missing” doctors to meet the needs of the population. Results The study shows a deficit in care-seeking for specialty care, in particular an incompatibility between care needs and care offers in the living environment, as well as strong territorial inequalities, with marked differences between private consumption and hospital consumption. The region experiences a deficit of 25% of liberal medical specialists in order to meet the needs of its population. Conclusions Accessibility to care is not only defined by the proximity of doctors, and their density; the proximity of areas of activity being a factor associated with better access to health care. This study also makes it possible to identify priority areas of action, specialty by specialty, to strengthen access to specialty care, and propose a fairer distribution of the care offer, in particular through interns’ internships, and the coordinated and territorial organization of specialist doctors.
Collapse
Affiliation(s)
| | - Sébastien Lecourieux
- Direction de la Coordination Régionale de la Gestion – Assurance Maladie du Loiret – Orléans – France
| | - Frédérique Ménoret
- Direction de la Coordination Régionale de la Gestion – Assurance Maladie du Loiret – Orléans – France
| | | | | | | |
Collapse
|
5
|
Cvietusa PJ, Goodrich GK, Shoup JA, King DK, Bender BG. Effect of an Asthma Exacerbation on Medication Adherence. J Allergy Clin Immunol Pract 2023; 11:248-254. [PMID: 36280138 PMCID: PMC10942659 DOI: 10.1016/j.jaip.2022.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few studies have looked at the effect of an asthma exacerbation on asthma medication adherence. OBJECTIVE To measure asthma medication adherence in the 12 months after an asthma exacerbation and the influence of care type (specialist vs primary care provider) as well as social economic status on adherence. METHODS We measured portion of days covered (PDC) during the 12 months before and after an exacerbation in a cohort of patients with asthma who were aged 18 years and older. Subanalyses looked at PDC in those who had more than one exacerbation after the sentinel exacerbation, by type of care received (primary care, allergist or pulmonologist, or no care) during both periods and by socioeconomic status (SES), defined as the lower quartile of annual income for the group. RESULTS In a cohort of 1,697 patients, PDC improved significantly (from 0.44 to 0.53; P < .001) after an asthma exacerbation. Improvement in PDC was even greater (from 0.45 to 0.57; P < .001) if they had more than one exacerbation after the sentinel exacerbation. Being seen by a specialist after the exacerbation but not before it, resulted in the greatest improvement in PDC (0.17 mean change). Patients not seen by a specialist either before the exacerbation or after had a mean change of just 0.07. Those with a lower SES had an overall lower PDC before the exacerbation (0.37 vs 0.43) but saw a similar improvement in the PDC compared with those in a higher SES (0.09 vs 0.10). CONCLUSIONS An asthma exacerbation is associated with a significant and sustained effect on medication adherence.
Collapse
Affiliation(s)
- Peter J Cvietusa
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo; Department of Asthma, Allergy, and Immunology, Permanente Medical Group, Denver, Colo.
| | - Glenn K Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
| | - Diane K King
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, Alaska
| | - Bruce G Bender
- Center for Health Promotion, National Jewish Health, Denver, Colo
| |
Collapse
|
6
|
Hittle Gigli K, Barnes H. Letter to the Editor In Response to: "Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners" (Suh et al. 2022). Pediatr Cardiol 2023; 44:263-264. [PMID: 36376477 DOI: 10.1007/s00246-022-03047-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022]
Abstract
The authors present a Letter to the Editor in response to the recently published article: "Referring Provider Opinions of Pediatric Cardiology Evaluations Performed by Nurse Practitioners" by Suh et al. (Pediatr Cardiol, https://doi.org/10.1007/s00246-022-02959-0 , 2022).
Collapse
Affiliation(s)
| | - Hilary Barnes
- Widener University School of Nursing, Chester, PA, 19013, USA.
| |
Collapse
|
7
|
Sikorskii A, Segrin C, Crane TE, Chalasani P, Arslan W, Rainbow J, Hadeed M, Given C, Badger TA. Use of scheduled and unscheduled health services by cancer survivors and their caregivers. Support Care Cancer 2022; 30:7341-7353. [PMID: 35610320 PMCID: PMC10396393 DOI: 10.1007/s00520-022-07157-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose was to determine predictors of scheduled and unscheduled health services use by cancer survivors undergoing treatment and their informal caregivers. METHODS English- or Spanish-speaking adult cancer survivors undergoing chemotherapy or targeted therapy for a solid tumor cancer identified a caregiver (N = 380 dyads). Health services use over 2 months was self-reported by survivors and caregivers. Logistic regression models were used to relate the likelihood of service use (hospitalizations, emergency department [ED] or urgent care visits, primary care, specialty care) to social determinants of health (age, sex, ethnicity, level of education, availability of health insurance), and number of comorbid conditions. Co-habitation with the other member of the dyad and other member's health services use were considered as additional explanatory variables. RESULTS Number of comorbid conditions was predictive of the likelihood of scheduled health services use, both primary care and specialty care among caregivers, and primary care among survivors. Greater probability of specialty care use was associated with a higher level of education among survivors. Younger age and availability of health insurance were associated with greater unscheduled health services use (hospitalizations among survivors and urgent care or ED visits among caregivers). Unscheduled health services use of one member of the dyad was predictive of use by the other. CONCLUSIONS These findings inform efforts to optimize health care use by encouraging greater use of scheduled and less use of unscheduled health services. These educational efforts need to be directed especially at younger survivors and caregivers.
Collapse
Affiliation(s)
- Alla Sikorskii
- Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, 909 Wilson Road, Road 321, East Lansing, MI, 48824, USA.
| | - Chris Segrin
- Department of Communication, University of Arizona, Tucson, AZ, USA
| | | | | | - Waqas Arslan
- Vallewise Health, Phoenix, AZ, USA
- College of Medicine, University of Arizona, Phoenix, AZ, USA
| | | | - Mary Hadeed
- College of Nursing, University of Arizona, Phoenix, AZ, USA
| | - Charles Given
- College of Nursing, Michigan State University, East Lansing, USA
| | - Terry A Badger
- Community and Systems Health Science Division, College of Nursing, University of Arizona, Phoenix, AZ, USA
- Department of Psychiatry, College of Nursing, University of Arizona, Phoenix, AZ, USA
| |
Collapse
|
8
|
Kobau R, Zack MM, Sapkota S, Sajatovic M, Kiriakopoulos E. When and why US primary care providers do and do not refer their patients with new-onset seizures or existing epilepsy or seizure disorders to neurologists-2018 DocStyles. Epilepsy Behav 2021; 125:108385. [PMID: 34740091 PMCID: PMC11034734 DOI: 10.1016/j.yebeh.2021.108385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/03/2021] [Accepted: 10/16/2021] [Indexed: 11/27/2022]
Abstract
Monitoring primary care providers' (PCP) attitudes and experiences with referrals of their patients with new-onset seizures or existing epilepsy/seizure disorders may help evaluate whether interventions to coordinate PCP and neurology care reduce treatment gaps and improve patient outcomes. To examine PCPs' attitudes toward, and experiences with, referral to specialty care of their patients with new-onset seizures or existing epilepsy/seizure disorders, we used cross-sectional 2018 DocStyles data to examine study outcomes. We selected a subsample of respondents who had a practice with at least 1% of patients with an epilepsy/seizure disorder and who answered questions about this disorder. We stratified provider actions, referral behavior, and referral enabling factors and barriers by epilepsy/seizure disorder caseload and provider type. We examined different patterns of responses by referral behavior and provider type. The final sample (n = 1284) included 422 family practitioners, 432 internists, 233 pediatricians, and 197 nurse practitioners. Most PCPs refer their patients with new-onset seizures to a neurologist, particularly to determine or confirm the diagnosis and appropriate treatment. Strikingly, about 40% of PCPs did not indicate a referral if their epilepsy/seizure disorder patient was unresponsive to treatment. Internists less likely referred their patients than pediatricians, nurse practitioners, or family practitioners. Less than one-third of all practitioners consulted seizure treatment guidelines. Prompt appointments, communication with the PCP, the patient's insurance, and referral back to primary care may facilitate referrals. Interventions that enhance enabling factors for guidelines-based care and that can increase opportunities for PCPs to consult with neurologists and/or refer their patients with uncontrolled seizures to specialty care are warranted.
Collapse
Affiliation(s)
- Rosemarie Kobau
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 4770 Buford Highway NE, MS 107-6, Atlanta, GA 30341, USA.
| | - Matthew M Zack
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health, 4770 Buford Highway NE, MS 107-6, Atlanta, GA 30341, USA
| | - Sanjeeb Sapkota
- ASRT Inc., Epilepsy Program, Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Mail Stop 107-6, 4770 Buford Hwy, 30341 GA, USA
| | - Martha Sajatovic
- University Hospital Cleveland Medical Center, 10524 Euclid Ave, Cleveland, OH 44106, USA
| | - Elaine Kiriakopoulos
- Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755-1404, USA
| |
Collapse
|
9
|
Crijns TJ, Ring D, Koenig K, Fatehi A. Factors associated with return musculoskeletal specialty visits. J Orthop 2021; 27:23-27. [PMID: 34456527 DOI: 10.1016/j.jor.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/22/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Prior studies suggested that a greater number of return visits is associated with greater symptoms of depression and greater symptom intensity. Methods All new adult patients presenting for musculsoskeletal specialty care between October 2017 and October 2018 were included. Patients completed the PROMIS Global Health, the PHQ-2, and the GAD-7 as part of usual care. Results Accounting for confounders, having a return visit was associated with lower PROMIS Global Health, greater symptoms of depression, and greater symptoms of anxiety. Conclusions These findings provide support for the importance of 1) improved coordination with non-specialist referring clinicians, and 2) interdisciplinary care teams. Level of evidence Level II, Prognostic.
Collapse
Affiliation(s)
- Tom J Crijns
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Karl Koenig
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
10
|
Feyman Y, Legler A, Griffith KN. Appointment wait time data for primary & specialty care in veterans health administration facilities vs. community medical centers. Data Brief 2021; 36:107134. [PMID: 34095383 PMCID: PMC8166772 DOI: 10.1016/j.dib.2021.107134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/23/2021] [Accepted: 05/05/2021] [Indexed: 11/21/2022] Open
Abstract
The datasets summarized in this article include more than 38 million appointment wait times that U.S. military veterans experienced when seeking medical care since January 2014. Our data include both within Veterans Health Administration (VHA) facilities and community medical centers, and wait times are stratified by primary/specialty care type. Deidentified wait time data are reported at the referral-level, at the VHA facility-level, and at the patient's 3-digit ZIP code-level. As of this writing, no other U.S. health care system has made their wait times publicly available. Our data thus represent the largest, national, and most representative measures of timely access to care for patients of both VHA and community providers. Researchers may use these datasets to identify variations in appointment wait times both longitudinally and cross-sectionally, conduct research on policies and interventions to improve access to care, and to incorporate fine-grained measures of wait times into their analyses.
Collapse
Affiliation(s)
- Yevgeniy Feyman
- Department of Health Law, Policy & Management, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States.,Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, United States
| | - Aaron Legler
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, United States
| | - Kevin N Griffith
- Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, United States.,Department of Health Policy, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN 37203, United States
| |
Collapse
|
11
|
Saloner B, Maclean JC. Specialty Substance Use Disorder Treatment Admissions Steadily Increased In The Four Years After Medicaid Expansion. Health Aff (Millwood) 2021; 39:453-461. [PMID: 32119615 DOI: 10.1377/hlthaff.2019.01428] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Affordable Care Act's Medicaid expansion provided insurance coverage to many low-income adults with substance use disorders, but it is unclear whether this led to more people receiving treatment. We used the Treatment Episode Data Set and a difference-in-differences approach to compare annual rates of specialty treatment admissions in expansion versus nonexpansion states in the period 2010-17. We found that admissions to treatment steadily increased in the four years after Medicaid expansion, with 36 percent more people entering treatment by the fourth expansion year in expansion states compared to nonexpansion states. Changes were largest for people entering intensive outpatient programs and those seeking medication treatment for opioid use disorder. The share of admissions paid for by Medicaid increased 23 percentage points in expansion states compared to nonexpansion states, largely displacing treatment paid for by state and local governments. The gradual increase in specialty substance use disorder treatment admissions after Medicaid expansion may reflect improving capacity and access to care.
Collapse
Affiliation(s)
- Brendan Saloner
- Brendan Saloner ( bsaloner@jhu. edu ) is an associate professor in the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Johanna Catherine Maclean
- Johanna Catherine Maclean is an associate professor of economics at Temple University, in Philadelphia, Pennsylvania, and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts
| |
Collapse
|
12
|
Lin SC, Yan PL, Moloci NM, Lawton EJ, Ryan AM, Adler-Milstein J, Hollingsworth JM. Out-Of-Network Primary Care Is Associated With Higher Per Beneficiary Spending In Medicare ACOs. Health Aff (Millwood) 2021; 39:310-318. [PMID: 32011939 DOI: 10.1377/hlthaff.2019.00181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite expectations that Medicare accountable care organizations (ACOs) would curb health care spending, their effect has been modest. One possible explanation is that ACOs' inability to prohibit out-of-network care limits their control over spending. To examine this possibility, we examined the association between out-of-network care and per beneficiary spending using national Medicare data for 2012-15. While there was no association between out-of-network specialty care and ACO spending, each percentage-point increase in receipt of out-of-network primary care was associated with an increase of $10.79 in quarterly total ACO spending per beneficiary. When we broke down total spending by place of service, we found that out-of-network primary care was associated with higher spending in outpatient, skilled nursing facility, and emergency department settings, but not inpatient settings. Our findings suggest an opportunity for the Medicare program to realize substantial savings, if policy makers developed explicit incentives for beneficiaries to seek more of their primary care within network.
Collapse
Affiliation(s)
- Sunny C Lin
- Sunny C. Lin is an assistant professor of public health at the Oregon Health & Science University-Portland State University School of Public Health, in Portland, Oregon
| | - Phyllis L Yan
- Phyllis L. Yan is a senior statistician in the Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School, in Ann Arbor
| | - Nicholas M Moloci
- Nicholas M. Moloci is a statistician lead in the Dow Division of Health Services Research, Department of Urology, University of Michigan Medical School
| | - Emily J Lawton
- Emily J. Lawton is a doctoral candidate in the Department of Health Management and Policy, University of Michigan
| | - 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
| | - Julia Adler-Milstein
- Julia Adler-Milstein is an associate professor of medicine and director of the Clinical Informatics and Improvement Research Center, School of Medicine, University of California San Francisco
| | - John M Hollingsworth
- John M. Hollingsworth ( kinks@med. umich. edu ) is an associate professor of urology and health management and policy at the University of Michigan Medical School and School of Public Health
| |
Collapse
|
13
|
Vanneman ME, Wagner TH, Shwartz M, Meterko M, Francis J, Greenstone CL, Rosen AK. Veterans' Experiences With Outpatient Care: Comparing The Veterans Affairs System With Community-Based Care. Health Aff (Millwood) 2020; 39:1368-1376. [PMID: 32744943 PMCID: PMC10031805 DOI: 10.1377/hlthaff.2019.01375] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Timely access to outpatient care was a primary driver behind the Department of Veterans Affairs' (VA's) increased purchase of community-based care under the Veterans Access, Choice, and Accountability Act of 2014, known as the Choice Act. To compare veterans' experiences in VA-delivered and community-based outpatient care after implementation of the act, we assessed veterans' scores on four dimensions of experience-access, communication, coordination, and provider rating-for outpatient specialty, primary, and mental health care received during 2016-17. Patient experiences were better for VA than for community care in all respects except access. For specialty care, access scores were better in the community; for primary and mental health care, access scores were similar in the two settings. Although all specialty care scores and the primary care coordination score improved over time, the gaps between settings did not shrink. As purchased care further expands under the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, which replaced the Choice Act in 2019, monitoring of meaningful differences between settings should continue, with the results used to inform both VA purchasing decisions and patients' care choices.
Collapse
Affiliation(s)
- Megan E Vanneman
- Megan E. Vanneman is a core investigator and Career Development Award recipient at the Veterans Affairs (VA) Salt Lake City's Informatics, Decision-Enhancement and Analytic Sciences Center, in Salt Lake City, Utah
| | - Todd H Wagner
- Todd H. Wagner is the director of the Health Economics Resource Center and assistant director and research career scientist at the VA Palo Alto Health Care System's Center for Innovation to Implementation, in Menlo Park, California
| | - Michael Shwartz
- Michael Shwartz is an investigator at the VA Boston Healthcare System's Center for Healthcare Organization and Implementation Research, in Boston, Massachusetts
| | - Mark Meterko
- Mark Meterko is a survey methodologist in the Office of Reporting, Analytics, Performance, Improvement, and Deployment at the ENRM Veterans Affairs Medical Center, in Bedford, Massachusetts
| | - Joseph Francis
- Joseph Francis is the chief improvement and analytics officer in the Office of Reporting, Analytics, Performance, Improvement, and Deployment at the Veterans Health Administration, Department of Veterans Affairs, in Washington, D.C
| | - Clinton L Greenstone
- Clinton L. Greenstone is the deputy executive director of clinical integration in the Office of Community Care at the Veterans Health Administration, Department of Veterans Affairs
| | - Amy K Rosen
- Amy K. Rosen is a core investigator and senior research career scientist at the VA Boston Healthcare System's Center for Healthcare Organization and Implementation Research
| |
Collapse
|
14
|
Ellis S, Geana M, Griebling T, McWilliams C, Gills J, Stratton K, Mackay C, Shifter A, Zganjar A, Thrasher B. Development, acceptability, appropriateness and appeal of a cancer clinical trials implementation intervention for rural- and minority-serving urology practices. Trials 2019; 20:578. [PMID: 31590694 PMCID: PMC6781342 DOI: 10.1186/s13063-019-3658-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Few community urologists offer cancer patients the opportunity to participate in cancer clinical trials, despite national guidelines that recommend it, depriving an estimated 260,000 urological cancer patients of guideline-concordant care each year. Existing strategies to increase urologists’ offer of clinical trials are designed for resource-rich environments and are not feasible for many community urologists. We sought to design an implementation intervention for dissemination in under-resourced community urology practices and to compare its acceptability, appropriateness and adoption appeal among trial-naïve and trial-experienced urologists. Methods We used a design-for-dissemination approach, informed by the Theoretical Domains Framework and Behavior Change Wheel, to match determinants of the clinical trial offer to theoretically informed implementation strategies. We described the implementation intervention in evaluation workshops offered at urology professional society meetings. We surveyed participants to assess the implementation intervention’s acceptability and appropriateness using validated instruments. We also measured adoption appeal, intention to adopt and previous trial offer. Results Our design process resulted in a multi-modal implementation intervention, comprised of multiple implementation strategies designed to address six domains from the Theoretical Domains Framework. Evaluation workshops delivered at four meetings, convened five separate professional societies. Sixty-one percent of those offered an opportunity to participate in the implementation intervention indicated intention to adopt. Average implementation intervention acceptability and appropriateness ratings were 4.4 and 4.4 (out of 5), respectively. Acceptability scores were statistically significantly higher among those offering trials compared to those not (p = 0.03). Appropriateness scores did not differ between those offering trials and those not (p = 0.24). After urologists ranked their top three innovation attributes, 43% of urologists included practice reputation in their top three reasons for offering clinical trials; 30% listed practice differentiation among their top three reasons. No statistically significant differences were found between those who offered trials and those who did not among any of the innovation attributes. Conclusions LEARN|INFORM|RECRUIT is a promising implementation intervention to address low accrual to clinical trials, poised for implementation and effectiveness testing. The implementation intervention is appealing to its target audience and may have equal uptake among trial-naïve and trial-experienced practices. Electronic supplementary material The online version of this article (10.1186/s13063-019-3658-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Shellie Ellis
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 3044, Kansas City, KS, 66160, USA.
| | - Mugur Geana
- School of Journalism and Mass Communications, University of Kansas, Lawrence, KS, USA
| | - Tomas Griebling
- Department of Urology and The Landon Center on Aging, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Charles McWilliams
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jessie Gills
- Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kelly Stratton
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Christine Mackay
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 3044, Kansas City, KS, 66160, USA
| | - Ariel Shifter
- Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Blvd., MS 3044, Kansas City, KS, 66160, USA
| | - Andrew Zganjar
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Brantley Thrasher
- Department of Urology, University of Kansas School of Medicine, Kansas City, KS, USA
| |
Collapse
|
15
|
Peterson EL, Ndumele CD, Busch SH. National Referral and Treatment Patterns Among Mental Health Pediatric Primary Care Visits. Adm Policy Ment Health 2020; 47:86-93. [PMID: 31542836 DOI: 10.1007/s10488-019-00972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits (N = 2056). Results of a logistic regression indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in comparison to those with ADHD (OR = 4.75, SE = 1.37). Other characteristics associated with increased likelihood of referral were those with comorbid mental health conditions (OR = 2.20, SE = 0.84) and those from a metropolitan area (OR = 2.23, SE = 0.75). Implications are discussed.
Collapse
|
16
|
Azad GF, Singh V, Kalb L, Pinkett-Davis M, Landa R. Child and Family Characteristics that Predict Autism Spectrum Disorder Specialty Clinic Appointment Attendance and Alignment with Providers. J Autism Dev Disord 2019; 49:3060-3072. [PMID: 31030311 DOI: 10.1007/s10803-019-04027-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We examined factors contributing to initial appointment attendance, alignment between parents' pre-visit and clinicians' diagnostic impressions, and family commitment to follow-ups at an autism spectrum disorder (ASD) specialty clinic. Sample sizes were n = 6558 (initial), n = 1430 (alignment), and n = 1353 (follow-up). Parents completed surveys and clinicians provided their ASD diagnostic impressions. When children were not receiving intervention, families were less likely to keep their initial appointment. Families residing long distances and having older children were less likely to keep their initial and follow-up appointments. African American families were less likely to keep their initial appointment and expressed initial doubts with providers about the diagnosis. Findings suggest that some children are not getting diagnostic clarity or accessing timely services.
Collapse
Affiliation(s)
- Gazi F Azad
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA.
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Vini Singh
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Luke Kalb
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD, 21205, USA
| | - Melanie Pinkett-Davis
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
| | - Rebecca Landa
- Kennedy Krieger Institute's Center for Autism and Related Disorders, 3901 Greenspring Avenue, Baltimore, MD, 21211, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 733 North Broadway, Baltimore, MD, 21205, USA
| |
Collapse
|
17
|
Greenwood-Lee J, Jewett L, Woodhouse L, Marshall DA. A categorisation of problems and solutions to improve patient referrals from primary to specialty care. BMC Health Serv Res 2018; 18:986. [PMID: 30572898 PMCID: PMC6302393 DOI: 10.1186/s12913-018-3745-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving access to specialty care has been identified as a critical issue in the delivery of health services, especially given an increasing burden of chronic disease. Identifying and addressing problems that impact access to specialty care for patients referred to speciality care for non-emergent procedures and how these deficiencies can be managed via health system delivery interventions is important to improve care for patients with chronic conditions. However, the primary-specialty care interface is complex and may be impacted by a variety of potential health services delivery deficiencies; with an equal range of interventions developed to correct them. Consequently, the literature is also diverse and difficult to navigate. We present a narrative review to identify existing literature, and provide a conceptual map that categorizes problems at the primary-specialty care interface with linkages to corresponding interventions aimed at ensuring that patient transitions across the primary-specialty care interface are necessary, appropriate, timely and well communicated. METHODS We searched MEDLINE and EMBASE databases from January 1, 2005 until Dec 31, 2014, grey literature and reference lists to identify articles that report on interventions implemented to improve the primary-specialty care interface. Selected articles were categorized to describe: 1) the intervention context, including the deficiency addressed, and the objective of the intervention 2) intervention activities, and 3) intervention outcomes. RESULTS We identified 106 articles, producing four categories of health services delivery deficiencies based in: 1) clinical decision making; 2) information management; 3) the system level management of patient flows between primary and secondary care; and 4) quality-of-care monitoring. Interventions were divided into seven categories and fourteen sub-categories based on the deficiencies addressed and the intervention strategies used. Potential synergies and trade-offs among interventions are discussed. Little evidence exists regarding the synergistic and antagonistic interactions of alternative intervention strategies. CONCLUSION The categorization acts as an aid in identifying why the primary-specialty care interface may be failing and which interventions may produce improvements. Overlap and interconnectedness between interventions creates potential synergies and conflicts among co-implemented interventions.
Collapse
Affiliation(s)
- James Greenwood-Lee
- Centre for Science, Athabasca University, 6th Floor, 345 6 Avenue SE, Calgary, Alberta, T2G 4V1, Canada
| | - Lauren Jewett
- Geography & Planning, University of Toronto, Sidney Smith Hall, Rm 594, 100 St George St., Toronto, Ontario, M5S 3G3, Canada
| | - Linda Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, 3-10 Corbett Hall, 8205 114 Street, Edmonton, Alberta, T6G 2G4, Canada
| | - Deborah A Marshall
- Canada Research Chair, Health Services and Systems Research, Arthur J.E. Child Chair in Rheumatology Outcomes Research, Department of Community Health Sciences, University of Calgary, Calgary, Canada.
- 3C56 Health Research Innovation Centre (HRIC), 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
| |
Collapse
|
18
|
Pedersen ER, Rubenstein L, Kandrack R, Danz M, Belsher B, Motala A, Booth M, Larkin J, Hempel S. Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression. Implement Sci 2018; 13:99. [PMID: 30029676 PMCID: PMC6053754 DOI: 10.1186/s13012-018-0788-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/29/2018] [Indexed: 12/11/2022] Open
Abstract
Background Depression is a common mental health disorder for which clinical practice guidelines have been developed. Prior systematic reviews have identified complex organizational interventions, such as collaborative care, as effective for guideline implementation; yet, many healthcare delivery organizations are interested in less resource-intensive methods to increase provider adherence to guidelines and guideline-concordant practices. The objective of this systematic review was to assess the effectiveness of healthcare provider interventions that aim to increase adherence to evidence-based treatment of depression in routine clinical practice. Methods We searched five databases through August 2017 using a comprehensive search strategy to identify English-language randomized controlled trials (RCTs) in the quality improvement, implementation science, and behavior change literature that evaluated outpatient provider interventions, in the absence of practice redesign efforts, to increase adherence to treatment guidelines or guideline-concordant practices for depression. We used meta-analysis to summarize odds ratios, standardized mean differences, and incidence rate ratios, and assessed quality of evidence (QoE) using the GRADE approach. Results Twenty-two RCTs promoting adherence to clinical practice guidelines or guideline-concordant practices met inclusion criteria. Studies evaluated diverse provider interventions, including distributing guidelines to providers, education/training such as academic detailing, and combinations of education with other components such as targeting implementation barriers. Results were heterogeneous and analyses comparing provider interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies. There was some evidence that provider interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated more complex provider interventions may be associated with more favorable outcomes. We did not identify types of provider interventions that were consistently associated with improvements across indicators of adherence and across studies. Effects on patients’ health in these RCTs were inconsistent across studies and outcomes. Conclusions Existing RCTs describe a range of provider interventions to increase adherence to depression guidelines. Low QoE and lack of replication of specific intervention strategies across studies limited conclusions that can be drawn from the existing research. Continued efforts are needed to identify successful strategies to maximize the impact of provider interventions on increasing adherence to evidence-based treatment for depression. Trial registration PROSPERO record CRD42017060460 on 3/29/17 Electronic supplementary material The online version of this article (10.1186/s13012-018-0788-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA.
| | - Lisa Rubenstein
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA.,David Geffen School of Medicine at UCLA, Los Angeles, USA.,UCLA Fielding School of Public Health, Los Angeles, USA
| | | | - Marjorie Danz
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Bradley Belsher
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, USA.,Uniformed Services University of the Health Sciences, Department of Psychiatry, Bethesda, USA
| | - Aneesa Motala
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Marika Booth
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | | | - Susanne Hempel
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| |
Collapse
|
19
|
Best C, Coe J, Hewson J, Meehan M, Kelton D. Survey of Equine Referring Veterinarians' Satisfaction with Their Most Recent Equine Referral Experience. J Vet Intern Med 2018; 32:822-831. [PMID: 29469978 PMCID: PMC5867021 DOI: 10.1111/jvim.15053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/07/2017] [Accepted: 01/08/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Little is known about the veterinary referral process and factors that contribute to positive outcomes. OBJECTIVE To investigate equine referring veterinarians' (rDVMs') satisfaction with their most recent referral experience and compare rDVM and specialist perspectives. SAMPLE 187 rDVMs and 92 specialists (referral care providers). METHODS Cross-sectional observational study. An online survey was administered to both rDVMs and specialists. Referring veterinarian satisfaction with their most recent referral experience was evaluated. Both rDVMs and specialists were asked to identify factors influencing a rDVM's decision where to refer, and the top 3 factors they perceive are barriers to referral care. RESULTS Median rDVM satisfaction with their most recent referral care experience was 80 of 100 (mean, 75; range, 8-100). Referring veterinarians provided the lowest satisfaction score for the item asking about "The competition the referral hospital poses to your practice" (mean, 56.96; median, 62; range, 0-100). The top factor rDVMs identified as influencing their decision where to refer was "quality of care," whereas specialists identified "quality of communication and updates from the clinician." Referring veterinarians' top barrier to referral care was "high cost of referral care," and for specialists was "poor service provided to the client by the referral hospital." CONCLUSIONS AND CLINICAL IMPORTANCE Referring veterinarians generally were satisfied with referral care, but areas exist where rDVMs and specialists differ in what they view as important to the referral process. Exploring opportunities to overcome these differences is likely to support high quality care.
Collapse
Affiliation(s)
- C. Best
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - J.B. Coe
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - J. Hewson
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - M. Meehan
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| | - D. Kelton
- Departments of Population Medicine (Best, Coe, Meehan, Kelton), and Clinical Studies (Hewson)Ontario Veterinary College, University of GuelphGuelphONCanada
| |
Collapse
|
20
|
Abouljoud M, Ryan M, Eshelman A, Bryce K, Jesse MT. Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm. J Clin Psychol Med Settings 2018; 25:267-277. [PMID: 29468571 DOI: 10.1007/s10880-017-9532-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient's presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.
Collapse
Affiliation(s)
- Marwan Abouljoud
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Michael Ryan
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Anne Eshelman
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Kelly Bryce
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Michelle T Jesse
- Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA.
- Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA.
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, 48202, USA.
| |
Collapse
|
21
|
Abstract
Comorbid behavioral and physical health conditions are accompanied by troubling symptom burden, functional impairment, and treatment complexity. Pediatric subspecialty care clinics offer an opportunity for the implementation of integrated behavioral health (BH) care models that promote resiliency. This article reviews integrated BH care in oncology, palliative care, pain, neuropsychiatry, cystic fibrosis, and transplantation. Examples include integrated care mandates, standards of care, research, and quality improvement by child and adolescent psychiatrists (CAPs) and allied BH clinicians. The role of CAPs in integrated BH care in subspecialty care is explored, focusing on cost, resource use, financial support, and patient and provider satisfaction.
Collapse
Affiliation(s)
- Chase Samsel
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, 450 Brookline Avenue, SW360A, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Monique Ribeiro
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Department of Anesthesiology, Perioperative and Pain Medicine, 333 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA
| | - Patricia Ibeziako
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - David R DeMaso
- Department of Psychiatry, 300 Longwood Avenue, Boston Children's Hospital, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| |
Collapse
|
22
|
Aljohani R, Gladman DD, Su J, Urowitz MB. Comparison of systemic lupus erythematosus (SLE) patients managed early after diagnosis in specialty versus community care clinics. Clin Rheumatol 2017; 36:1773-8. [PMID: 28589322 DOI: 10.1007/s10067-017-3713-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 04/20/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
To compare management and outcomes of SLE patients treated in community clinics (Cc) with those treated in specialty clinic (Sc) within 10 years after SLE diagnosis. A single-center, matched cohort study design was used. We identified 54 SLE patients who were referred to a Sc from Cc within 5 years of SLE diagnosis, and 101 inception SLE patients who followed in a Sc. Patients in Cc were matched 1:2 based on gender, decade of SLE diagnosis, and age at diagnosis within 3 years with Sc patients. Disease characteristics, damage accumulation, death, cardiovascular (CVS) risk factors, and events were compared at 5 and 10 years of disease. Regression analyses taking into account the paired data were conducted. At 5 years of disease, patients referred from Cc had less cumulative ACR criteria, but more active disease. They were on higher doses of glucocorticoids (GCS) but less antimalarial treatment. At 10 years of disease and follow-up entirely in Sc, Sc patients had less disease activity. They had lower cumulative GCS doses. They had less hypertension and osteoporosis but more hypercholesterolemia than Cc patients. No statistically significant difference in damage accrual, CVS events, and death were detected. Regression analysis confirmed an association between being inception Sc patients and less active disease at 10 years. Lupus patients should be under the care of a lupus specialist early in their disease course for better control of their disease activity and to minimize use of GCS.
Collapse
|
23
|
Stillman MD, Bertocci G, Smalley C, Williams S, Frost KL. Healthcare utilization and associated barriers experienced by wheelchair users: A pilot study. Disabil Health J 2017; 10:502-508. [PMID: 28245968 DOI: 10.1016/j.dhjo.2017.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 12/06/2016] [Accepted: 02/09/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND More than twenty-five years after passage of the ADA, little remains known about the experiences of wheelchair users when attempting to access health care and how accessibility may influence health care utilization. OBJECTIVE/HYPOTHESIS To describe health care utilization among wheelchair users and characterize barriers encountered when attempting to obtain access to health care. METHODS An internet-based survey of wheelchair users was conducted. Measures included demographics, condition, socioeconomic status, health care utilization and receipt of preventive services within the past year, physical barriers encountered at outpatient facilities, and satisfaction with care. RESULTS Four hundred thirty-two wheelchair users responded to the survey. Nearly all respondents (97.2%) had a primary care appointment within the past year and most reported 3-5 visits to both primary and specialty care providers. Most encountered physical barriers when accessing care (73.8% primary, 68.5% specialty). Participants received most preventive interventions at rates similar to national averages with the exception of Pap tests. Most participants remained clothed for their primary care evaluation (76.1%), and were examined seated in their wheelchair (69.7%). More than half of participants (54.1%) felt they received incomplete care, and 57% believed their physician had no more than a moderate understanding of their disability-specific medical concerns. CONCLUSIONS Wheelchair users face persistent barriers to care, may receive less than thorough physical evaluations, receive fewer screenings for cervical cancer, and largely believe they receive incomplete care.
Collapse
Affiliation(s)
- Michael D Stillman
- Department of Internal Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA; Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Gina Bertocci
- Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA.
| | - Craig Smalley
- Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA.
| | - Steve Williams
- Department of Rehabilitation Medicine, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, USA.
| | - Karen L Frost
- Department of Bioengineering, University of Louisville School of Engineering, 550 S. Preston Street, Rm. 204 Health Sciences Research Tower, Louisville, KY 40202, USA.
| |
Collapse
|
24
|
Foster MA, Xing J, Moorman AC, Boscarino J, Gordon SC, Lu M, Rupp L, Schmidt MA, Trinacty CM, Xu F, Holmberg SD, Spradling PR. Frequency of and Factors Associated with Receipt of Liver-Related Specialty Care Among Patients with Hepatitis C in the Chronic Hepatitis Cohort Study. Dig Dis Sci 2016; 61:3469-3477. [PMID: 27510752 DOI: 10.1007/s10620-016-4269-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/26/2016] [Indexed: 12/09/2022]
Abstract
BACKGROUND Linking persons with hepatitis C virus (HCV) to care and treatment is critical to reduction in disease burden; typically, this entailed referral to a specialist. However, data regarding the frequency and factors associated with referral among patients in healthcare organizations (HCOs) are lacking. METHODS Among persons in four US HCOs with newly diagnosed HCV during 2006-2011, we determined the frequency of liver-related specialist care after diagnosis. We also identified sociodemographic and clinical characteristics associated with such care by multivariate analysis, adjusted for all variables. RESULTS Among 3592 patients with newly diagnosed HCV, 57 % (range among sites 45-90 %) received specialist care; of these, 57 % received care within 90 days of diagnosis. Patient characteristics associated with receipt of specialist care included: affiliation with one of the study sites [adjusted odds ratio (aOR) 4.8 vs. the referent site); having Medicare plus private insurance (aOR 1.6 vs. Medicaid); and having elevated alanine aminotransferase (ALT) (aOR 1.6 vs. normal ALT) or lower platelet values (aOR 1.4 vs. normal platelet level). Specialist care within 90 days of diagnosis was associated with private insurance (aOR 1.5 vs. Medicaid), elevated ALT levels (aOR 1.3-2.3 vs. normal), and having ≥2 comorbid conditions (aOR 1.4 vs. no comorbid conditions). Compared to patients not referred, those referred were more likely to be treated (aOR 3.5). CONCLUSIONS Receipt of specialist care among persons with newly diagnosed HCV varied among HCOs. Clinical evidence of liver disease and having private insurance were associated with prompt receipt of specialist care and HCV treatment.
Collapse
Affiliation(s)
- Monique A Foster
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA.
| | - Jian Xing
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Anne C Moorman
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Joseph Boscarino
- Geisinger Health System, 100 N. Academy Avenue, Danville, PA, 17866, USA
| | - Stuart C Gordon
- Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Mei Lu
- Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Loralee Rupp
- Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Mark A Schmidt
- Kaiser Permanente Health Research, 3800 N. Interstate Avenue, Portland, OR, 97227, USA
| | - Connie M Trinacty
- Kaiser Permanente Health Research, 501 Alakawa Street, Suite 201, Honolulu, HI, 96817, USA
| | - Fujie Xu
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Scott D Holmberg
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| | - Philip R Spradling
- Division of Viral Hepatitis, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop G-37, Atlanta, GA, 30329, USA
| |
Collapse
|
25
|
Sewell JL, Day LW, Tuot DS, Alvarez R, Yu A, Chen AH. A brief, low-cost intervention improves the quality of ambulatory gastroenterology consultation notes. Am J Med 2013; 126:732-8. [PMID: 23791206 PMCID: PMC3730533 DOI: 10.1016/j.amjmed.2013.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Effective communication between primary care providers and specialty providers is important to facilitate high-quality specialty care. Few studies have assessed the quality of communication from specialist to primary care providers or implemented interventions to improve quality. We developed a brief, low-cost intervention designed to improve the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners in our urban health care system. METHODS Six physicians (3 specialists and 3 primary care providers) scored pre- and postintervention notes using an objective quality assessment instrument that had excellent inter-rater reliability. They were blinded to note date, author, and pre/postintervention status. The primary outcome was improvement in Composite Quality Score, an objective, comprehensive assessment of quality. Secondary outcomes included improvements in 3 specific domains, and Global Quality Score (a subjective measure of quality). RESULTS Two hundred pre- and 200 postintervention notes written by 6 fellows and 2 nurse practitioners were included. Composite Quality Score improved from 3.74 (of 5) to 4.09 (P <.001 in adjusted analysis). All secondary outcomes improved in adjusted analyses as well. The largest increase was seen in Communication Domain (22% increase). Fellow-written notes had higher scores than nurse practitioner-written notes, but nurse practitioner-written notes improved to a greater degree. CONCLUSION A brief, low-cost intervention significantly improved the quality of ambulatory gastroenterology consultation notes written by fellows and nurse practitioners. Communication between primary care providers and specialists is an important area for further study.
Collapse
Affiliation(s)
- Justin L Sewell
- Center for Innovation in Access and Quality, Department of Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA.
| | | | | | | | | | | |
Collapse
|