Abstract：
STUDY QUESTION:Continuous quality improvement (CQI) has been implemented at least to some degree in many health care settings, yet randomized controlled trials (RCTs) of CQI are rare. We ask whether, when, and how RCTs of CQI might be designed. STUDY DESIGN:We consider two applications of CQI: as a general philosophy of management and (by analogy with the use of conceptual models from the behavioral sciences) as a conceptual model for developing specific interventions. The example of warfarin therapy for stroke prevention among patients with atrial fibrillation is used throughout. PRINCIPAL FINDINGS:While it is impractical to use RCTs to study CQI as a general management philosophy, RCT methodology is appropriate for studying CQI as a conceptual model for generating interventions. RCTs of CQI might be considered when the process change under consideration is very large, its implications (e.g., in terms of cost, outcomes of care, etc.) are very great, and the best approach is uncertain. When designing RCTs of CQI, critical decisions include (1) the unit of randomization; (2) whether the focus is on CQI as a method for generating interventions or, instead, is on specific interventions in and of themselves; and (3) the flexibility available to local personnel to modify the intervention's operational details. CONCLUSIONS:RCTs of CQI as a conceptual model for generating interventions are feasible.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Samsa G,Matchar Dkeywords:
subject
Has Abstractpub_date
2000-08-01 00:00:00pages
687-700issue
3eissn
0017-9124issn
1475-6773journal_volume
35pub_type
评论,杂志文章abstract：OBJECTIVE:To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. DATA SOURCES:Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2007.00762.x
更新日期：2008-02-01 00:00:00
abstract：OBJECTIVE:To construct a data tool, the Residential History File (RHF), that summarizes information from Medicare claims and nursing home (NH) Minimum Data Set (MDS) assessments to track people through health care locations, including non-Medicare-paid NH stays. DATA SOURCES:Online Survey of Certification and Reportin...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2010.01194.x
更新日期：2011-02-01 00:00:00
abstract：OBJECTIVE:To assess whether participation in a state publicly financed health insurance program, Massachusetts Children's Medical Security Plan (CMSP) , which is open to children regardless of income, was associated with disenrollment from private insurance. DATA SOURCES/STUDY DESIGN:A survey of participants in CMSP w...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-12-01 00:00:00
abstract：OBJECTIVE:To extend recent conceptual and methodological advances in disparities research to include the incorporation of genomic information in analyses of racial/ethnic disparities in health care and health outcomes. DATA SOURCES:Published literature on human genetic variation, the role of genetics in disease and re...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2012.01413.x
更新日期：2012-06-01 00:00:00
abstract：OBJECTIVE:To understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). DATA SOURCES/STUDY SETTING:Participants in 24 Community Deliberation groups (CD; n = 263), four Citizens' Panel groups (CP; n ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13175
更新日期：2019-12-01 00:00:00
abstract：OBJECTIVE:To examine trends in employer-sponsored health insurance coverage rates and its associated components between 2000 and 2008, to provide a baseline for later evaluations of the Affordable Care Act, and to provide information to policy makers as they design the implementation details of the law. DATA SOURCES:P...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2011.01368.x
更新日期：2012-06-01 00:00:00
abstract：OBJECTIVE:We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. DATA SOURCE:Uninsured U.S. citizens and noncitizens from the 2005-2006 and 2008-2009 Medical Expenditure Panel Survey. ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12193
更新日期：2014-12-01 00:00:00
abstract：OBJECTIVE:To develop a scale to measure patients' trust in health insurers, including public and private insurers and both indemnity and managed care. A scale was developed based on our conceptual model of insurer trust. The scale was analyzed for its factor structure, internal consistency, construct validity, and othe...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2002-02-01 00:00:00
abstract：OBJECTIVE:To assess the impact of out-migration of nurses on the health systems in sub-Saharan Africa (SSA). SETTING:The countries of SSA. DESIGN AND METHODS:Review of secondary sources: existing publications and country documents on the health workforce; documents prepared for the Joint Learning Initiative Global Hu...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2007.00712.x
更新日期：2007-06-01 00:00:00
abstract：OBJECTIVE:. To examine the effect of premiums and benefits on the health plan choices of older enrollees who choose Federal Employees Health Benefits Program (FEHBP) health plans as their primary payer. DATA SOURCES:Administrative enrollment data from the Office of Personnel Management (OPM) and plan premiums and bene...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2006.00580.x
更新日期：2006-10-01 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 examine the effect of the Medicare prospective payment system (PPS) for skilled nursing facilities (SNF) on the delivery of rehabilitation therapy to residents. DATA SOURCES:Resident-level data are based on the Resident Assessment Instrument Minimum Data Set for nursing facilities. All elderly residents a...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2004.00291.x
更新日期：2004-10-01 00:00:00
abstract：RESEARCH OBJECTIVE:This study examines small area variations in readmission rates to assess whether higher readmission rate in an area is associated with higher clusters of patients with multiple chronic conditions. STUDY DESIGN:The study uses hospital discharge data of adult (18+) patients in 6 U.S. states for 2009 f...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12401
更新日期：2016-06-01 00:00:00
abstract：OBJECTIVE:To examine the impact of mandatory HMO enrollment for Medicaid-covered pregnant women on prenatal care use, smoking, Cesarean section (C-section) use, and birth weight. DATA SOURCES/STUDY SETTING:Linked birth certificate and Medicaid enrollment data from July 1993 to June 1998 in 10 Ohio counties, 6 that imp...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2004.00260.x
更新日期：2004-08-01 00:00:00
abstract：OBJECTIVE:To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors' characteristics and low methadone dosage. DATA SOURCE:Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011. STUDY DE...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12558
更新日期：2017-10-01 00:00:00
abstract：:Limited information exists concerning lifetime use of nursing home services by the aged. This article examines the longitudinal experience, over four years, of elderly individuals at high risk of institutionalization, and develops a simple model of nursing home use based on these observations. This model allows us to ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1986-06-01 00:00:00
abstract：:The National Long Term Care Demonstration (channeling) was designed to provide coordinated community-based long-term care services to those older persons at high risk of nursing home placement. A key component of the program was the process established to accomplish this targeting effort. In this article, the outreach...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1988-04-01 00:00:00
abstract：OBJECTIVES:To quantify racial and socioeconomic status (SES) disparities in oral health, as measured by tooth loss, and to determine the role of dental care use and other factors in explaining disparities. DATA SOURCES/STUDY SETTING:The Florida Dental Care Study, comprising African Americans (AAs) and non-Hispanic whi...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2003.00205.x
更新日期：2003-12-01 00:00:00
abstract：OBJECTIVE:To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES:The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conduct...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.029
更新日期：2002-04-01 00:00:00
abstract：OBJECTIVE:To estimate the effect of a nursing home's share of residents with a serious mental illness (SMI) on the quality of care. DATA SOURCES:Secondary nursing home level data over the period 2000 through 2008 obtained from the Minimum Data Set, OSCAR, and Medicare claims. STUDY DESIGN:We employ an instrumental va...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12023
更新日期：2013-08-01 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:To examine which components of medical homes affect time families spend arranging/coordinating health care for their children with special health care needs (CSHCNs) and providing health care at home. DATA SOURCES:2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN), a population-...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12215
更新日期：2015-04-01 00:00:00
abstract：OBJECTIVE:To compare estimates of health coverage from the pre- and post- redesign of the Current Population Survey (CPS) Annual Social and Economic Supplement. DATA SOURCES/STUDY SETTING:The CPS 2013 Content Test. STUDY DESIGN:A test of the old and new CPS in which the control panel was a subset of the CPS productio...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12312
更新日期：2016-02-01 00:00:00
abstract：OBJECTIVE:To assess the impact of substance abuse claims redaction on Medicare spending estimates for beneficiaries with serious mental illness. DATA SOURCES:The 2012 claims and unredacted beneficiary-level Medicare spending totals from CMS's Chronic Conditions Warehouse. STUDY DESIGN:We identified beneficiaries with...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12528
更新日期：2017-06-01 00:00:00
abstract：OBJECTIVE:This study examines the degree to which a married individual's health habits and use of preventive medical care are influenced by his or her spouse's behaviors. STUDY DESIGN:Using longitudinal data on individuals and their spouses, we examine changes over time in the health habits of each person as a functio...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2007.00754.x
更新日期：2008-02-01 00:00:00
abstract：OBJECTIVE:To determine if members of commercial managed care and Medicaid managed care rate the experience with their health plans differently. DATA SOURCES:Data from both commercial and Medicaid Consumer Assessment of Health Plan Surveys (CAHPS) in New York State. STUDY DESIGN:Regression models were used to determin...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.00166
更新日期：2003-08-01 00:00:00
abstract：OBJECTIVE:To test the effects of state prescription contraception insurance mandates on unintended, mistimed, and unwanted births in a sample of privately insured recent mothers. DATA:We pooled Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1997 to 2012 to study 209,964 privately insured recent mothers ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12792
更新日期：2017-12-01 00:00:00
abstract：OBJECTIVES:(1) To examine the association of socioeconomic characteristics (SES) with hospitalization by age group, and when using measures of SES at the community as opposed to the individual level. (2) Thus, to support the inference that socioeconomic factors are important in the analysis of small area utilization da...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1998-06-01 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：OBJECTIVE:To compare the performance of various risk adjustment models in behavioral health applications such as setting mental health and substance abuse (MH/SA) capitation payments or overall capitation payments for populations including MH/SA users. DATA SOURCES/STUDY DESIGN:The 1991-93 administrative data from the...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-08-01 00:00:00
