Abstract:
OBJECTIVE:To examine the service experiences and outcomes of low-income Medicaid beneficiaries with disabilities under two different models for organizing home-based personal assistance services: agency-directed and consumer-directed. DATA SOURCE:A survey of a random sample of 1,095 clients, age 18 and over, who receive services in California's In-Home Supportive Services (IHSS) program funded primarily by Medicaid. Other data were obtained from the California Management and Payrolling System (CMIPS). STUDY DESIGN:The sample was stratified by service model (agency-directed or consumer-directed), client age (over or under age 65), and severity. Data were collected on client demographics, condition/functional status, and supportive service experience. Outcome measures were developed in three areas: safety, unmet need, and service satisfaction. Factor analysis was used to reduce multiple outcome measures to nine dimensions. Multiple regression analysis was used to assess the effect of service model on each outcome dimension, taking into account the client-provider relationship, client demographics, and case mix. DATA COLLECTION:Recipients of IHSS services as of mid-1996 were interviewed by telephone. The survey was conducted in late 1996 and early 1997. PRINCIPAL FINDINGS:On various outcomes, recipients in the consumer-directed model report more positive outcomes than those in the agency model, or they report no difference. Statistically significant differences emerge on recipient safety, unmet needs, and service satisfaction. A family member present as a paid provider is also associated with more positive reported outcomes within the consumer-directed model, but model differences persist even when this is taken into account. Although both models have strengths and weaknesses, from a recipient perspective the consumer-directed model is associated with more positive outcomes. CONCLUSIONS:Although health professionals have expressed concerns about the capacity of consumer direction to assure quality, particularly with respect to safety, meeting unmet needs, and technical quality, our findings suggest that the consumer-directed service model is a viable alternative to the agency model. Because public programs are under growing pressure to address the long-term care needs of low-income people of all ages with disabilities, the Medicaid personal assistance benefit needs to be reassessed in light of these findings. Consumer-directed models may offer a less elaborate and possibly less costly option for organizing supportive services at home. Study limitations may limit the generalizability of these findings. This was a natural experiment, in which only some counties offered both service models and counties assigned recipients to a service model. The use of a telephone survey excluded important recipient subsets, notably people with severe cognitive impairments. A more definitive study would include direct observations as well as survey approaches.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Benjamin AE,Matthias R,Franke TMkeywords:
subject
Has Abstractpub_date
2000-04-01 00:00:00pages
351-66issue
1 Pt 2eissn
0017-9124issn
1475-6773journal_volume
35pub_type
杂志文章abstract:OBJECTIVE:The objective of this study was to assess nonresponse error in telephone health survey data based on an address-based sample. DATA SOURCES:Telephone and in-person interviews in Greater Boston. STUDY DESIGN/DATA COLLECTION:Interviewers attempted telephone interviews at addresses that were matched to telephon...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13110
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To examine whether physicians attend to gender prevalence data in diagnostic decision making for coronary heart disease (CHD) and to test the hypothesis that previously reported gender differences in CHD diagnostic certainty are due to discrimination arising from reliance on prevalence data ("statistical disc...
journal_title:Health services research
pub_type: 评论,杂志文章
doi:10.1111/j.1475-6773.2009.01022.x
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that health systems provide better care to patients with high needs by comparing differences in quality between system-affiliated and nonaffiliated physician organizations (POs) and to examine variability in quality across health systems. DATA SOURCES:2015 Medicare Data on Provider Pra...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13570
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. DATA SOURCES:The data analyzed are from the National Consumer Assessment of Health Plans (CAHPS) Benchmarking Database 1.0 and consist of 9,540 children enrolled in ...
journal_title:Health services research
pub_type: 杂志文章,多中心研究
doi:
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. METHODS; We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01122.x
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:To assess the effects of an alternative method of paying home health agencies for services to Medicare beneficiaries, based on a demonstration program. DATA SOURCES/STUDY SETTING:Primary and secondary data collected on participating home health agencies in five states and their patients during the three-year...
journal_title:Health services research
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To understand patient loyalty to providers over time, informing effective population health management. STUDY SETTING:Patient care-seeking patterns over a 6-year timeframe in Minnesota, where care systems have a significant portion of their revenue generated by shared-saving contracts with public and private...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12147
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services' Nursing Home Compare website, on facility performance and consumer demand for services. DATA SOURCES:The nursing home Minimum Data Set facility reports f...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01298.x
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:To examine county-level geographic variation in treatment admissions among opioid treatment programs (OTPs) that accept Medicaid in the continental United States. DATA SOURCES/STUDY SETTING:Data come from the 2012 National Survey of Substance Abuse Treatment Services. STUDY DESIGN/DATA COLLECTION:We used lo...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12686
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:To investigate disparities in mental health care episodes, aligning our analyses with decisions to start or drop treatment, and choices made during treatment. STUDY DESIGN:We analyzed whites, blacks, and Latinos with probable mental illness from Panels 9-13 of the Medical Expenditure Panel Survey, assessing ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12095
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:To examine the relationship between features of managed care organizations (MCOs) and health care use patterns by children. DATA SOURCES:Telephone survey data from 2,223 parents of children with special health care needs, MCO-administrator interview data, and health care claims data. STUDY DESIGN:Cross-sect...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2003.00195.x
更新日期:2003-12-01 00:00:00
abstract::Thresholds for medical decision making are the probabilities of disease at which clinicians choose to initiate testing or therapy. A descriptive analysis of clinicians' decision making can derive their test and test-treatment thresholds and has the potential to explain variations in test utilization. A previously desc...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1986-02-01 00:00:00
abstract:OBJECTIVE:To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting. DATA SOURCES:Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2009.00994.x
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:To provide guidance on improving the quality of case studies in health services research. DATA SOURCES:Secondary data, drawing from previous case study research. RESEARCH DESIGN:Guidance is provided to two audiences: potential case study investigators (eight items) and reviewers of case study proposals (fou...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:
更新日期:1999-12-01 00:00:00
abstract:INTRODUCTION:America's community health centers (HCs) are uniquely poised to implement the patient-centered medical home (PCMH) model, as they are effective in providing comprehensive, accessible, and continuous primary care. This study aims to evaluate the relationship between PCMH recognition in HCs and clinical perf...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12523
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVES:(1) To identify resident and organizational factors associated with the use of advance care plans pre- and post-implementation of the Patient Self-Determination Act (PSDA), and (2) to identify changes (pre- and post-implementation of the PSDA) in the relationship between these factors and the use of advance ...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1998-04-01 00:00:00
abstract:PURPOSE:We report the validation of an instrument to measure mistrust of health care organizations and examine the relationship between mistrust and health care service underutilization. METHODS:We conducted a telephone survey of a random sample of households in Baltimore City, MD. We surveyed 401 persons and followed...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2009.01017.x
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVE:To assess the influence of relational climate on quality of diabetes care. DATA SOURCES/STUDY SETTING:The study was conducted at the Department of Veterans Affairs (VA). The VA All Employee Survey (AES) was used to measure relational climate. Patient and facility characteristics were gathered from VA adminis...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12675
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:To examine the impact of the Short Stay Transfer Policy (SSTP) on practice patterns. DATA SOURCES:This study uses data from the Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review (MEDPAR) file, Home Health Standard Analytical File, 1999 Provider of Service file, and data from th...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00606.x
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:To assess the impact of Enroll America's field outreach activities on the number of individuals enrolled in Marketplace coverage during the first open enrollment period. DATA SOURCES/STUDY SETTING:Marketplace enrollment for the initial open enrollment period linked with data on Enroll America's field activit...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12630
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVES:To explore effects of disease prevalence adjustment on ambulatory care-sensitive hospitalization (ACSH) rates used for quality comparisons. DATA SOURCES/STUDY SETTING:County-level hospital administrative data on adults discharged from German hospitals in 2011 and prevalence estimates based on administrative...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12680
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:Independent freestanding emergency departments (IFEDs) have proliferated over the last decade, largely in Texas. We examined the IFED physician workforce composition and changes in emergency physician workforce supply across states and in rural Texas over the period of IFED proliferation following a 2009 legi...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13587
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:The volume and cost of services consumed by persons with AIDS (PWAs) during their last months of life are examined in this study. DATA SOURCES:This study utilizes data from the AIDS Costs and Service Utilization Survey (ACSUS). The ACSUS is the most comprehensive survey of medical services that are consumed ...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Patients are treated using observation services (OS) when their care needs exceed standard outpatient care (i.e., clinic or emergency department) but do not qualify for admission. Medicare and other private payers seek to limit this care setting to 48 hours. DATA SOURCE/STUDY SETTING:Healthcare Cost and Uti...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12143
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:To estimate 2012 tax expenditures for employer-sponsored insurance (ESI) in the United States and to explore the sensitivity of estimates to assumptions regarding the incidence of employer premium contributions. DATA SOURCES:Nationally representative Medical Expenditure Panel Survey data from the 2005-2007 H...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12037
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:We estimate long-term health care costs of former smokers compared with continuing and never smokers using a retrospective cohort study of HMO enrollees. Previous research on health care costs associated with former smokers has suggested that quitters may incur greater health care costs than continuing smoker...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.00142
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVES:Methodologically sound mixed methods research can improve our understanding of health services by providing a more comprehensive picture of health services than either method can alone. This study describes the frequency of mixed methods in published health services research and compares the presence of meth...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01344.x
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:To determine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on birth outcomes. DATA SOURCE:The Child Development Supplement (CDS) of the Panel Study of Income Dynamics (PSID). The PSID provides extensive data on the income and well-being of a representative sa...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01115.x
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:To examine changes in children's albuterol use and out-of-pocket (OOP) costs in response to increased copayments after the Food and Drug Administration banned inhalers with chlorofluorocarbon (CFC) propellants. SETTING:Four health maintenance organizations (HMOs), two that increased copayments for albuterol ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12615
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:The Standard Gamble (SG) technique is recommended for measurement of individuals' preferences under uncertainty and to express the outcome of different therapeutic choices in utility values to be used in clinical decision analysis and health program evaluation. The article alerts users of this technique to pr...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00