Abstract:
OBJECTIVE:To compare process of care and outcome after acute myocardial infarction, for patients with and without mental illness, cared for in the Veterans Health Administration (VA) health care system. DATA SOURCES/SETTING:Primary clinical data from 81 VA hospitals. STUDY DESIGN:This was a retrospective cohort study of 4,340 veterans discharged with clinically confirmed acute myocardial infarction. Of these, 859 (19.8 percent) met the definition of mental illness. Measures were age-adjusted in-hospital and 90-day cardiac procedure use; age-adjusted relative risks (RE) of use of thrombolytic therapy, beta-blockers, angiotensin converting enzyme (ACE) inhibitors, or aspirin at discharge; risk-adjusted 30-day and one-year mortality. RESULTS:Patients with mental illness were marginally less likely than those without mental illness to undergo in-hospital angiography (age-adjusted RR 0.90 [95 percent confidence interval: 0.83, 0.98]), but there was no significant difference in the age-adjusted RR of coronary artery bypass graft surgery in the 90 days after admission (0.85 [0.69, 1.05]), or in the receipt of medications of known benefit. For example, ideal candidates with and without mental illness were equally likely to receive beta-blockers at the time of discharge (age-adjusted RR 0.92 [0.82, 1.02]). The risk-adjusted odds ratio (OR) for death in patients with mental illness versus those without mental illness within 30 days was 1.00 (0.75, 1.32), and for death within one year was 1.25 (1.00, 1.53). CONCLUSIONS:Veterans Health Administration patients with mental illness were marginally less likely than those without mental illness to receive diagnostic angiography, and no less likely to receive revascularization or medications of known benefit after acute myocardial infarction. Mortality at one year may have been higher, although this finding did not reach statistical significance. These findings are consistent with other studies showing reduced health care disparities in the VA for other vulnerable groups, and suggest that an integrated health care system with few financial barriers to health care access may attenuate some health care disparities. Further work should address how health care organizational features might narrow disparities in health care for vulnerable groups.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Petersen LA,Normand SL,Druss BG,Rosenheck RAdoi
10.1111/1475-6773.00104keywords:
subject
Has Abstractpub_date
2003-02-01 00:00:00pages
41-63issue
1 Pt 1eissn
0017-9124issn
1475-6773journal_volume
38pub_type
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journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12032
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To demonstrate how expanding services covered by a "bundled payment" can also expand variation in the costs of treating patients under the bundle, using the Medicare dialysis program as an example. DATA SOURCES/STUDY SETTING:Observational claims-based study of 197,332 Medicare hemodialysis beneficiaries enro...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12202
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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 test a conceptual model of relationships, reflection, sensemaking, and learning in primary care practices transitioning to patient-centered medical homes (PCMH). DATA SOURCES/STUDY SETTING:Primary data were collected as part of the American Academy of Family Physicians' National Demonstration Project of t...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12415
更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To examine how plan premiums are associated with physician network breadth, hospital network breadth, and hospital network quality on the Affordable Care Act's Health Insurance Marketplaces in all 50 states and the DC in 2016. DATA SOURCES:Data on plan premiums and characteristics came from 2016 Robert Wood ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13447
更新日期:2020-08-13 00:00:00
abstract:OBJECTIVE:To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. DATA SOURCES/STUDY SETTING:Primary data were collected on 5,314 nursing home residents in 156 ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00627.x
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California. DATA SOURCE:Secondary discharge data from the Office of Statewide Health Planning and Development for the State of California for the period 1989-1993. STUDY DESIGN:Outcome...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2003.00185.x
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVE:To examine the implications of serious and chronic health problems on the willingness of enrollees to switch health plans if they are dissatisfied with their current arrangements. DATA SOURCE:A large (20,283 respondents) survey of employees of three national corporations committed to the model of managed com...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1999-06-01 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 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
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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:CONTEXT:A1c levels are widely used to assess quality of diabetes care provided by health care systems. Currently, cross-sectional measures are commonly used for such assessments. OBJECTIVE:To study within-patient longitudinal changes in A1c levels at Veterans Health Administration (VHA) facilities as an alternative to...
journal_title:Health services research
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1475-6773.2005.00439.x
更新日期:2005-12-01 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:RESEARCH OBJECTIVE:To investigate disenrollment from public insurance at the 6-year transitional birthday when eligibility for many children moves from Medicaid to State Children's Health Insurance Program (S-CHIP). DATA SOURCES:Data from Georgia's S-CHIP (PeachCare) and Medicaid programs from 2000 to 2002. STUDY DES...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2007.00795.x
更新日期:2007-12-01 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:OBJECTIVE:Examination of the extent to which federal surveys provide the data needed to estimate the coverage/cost impacts of policy alternatives to address the problem of uninsurance. DATA SOURCES/STUDY SETTING:Assessment of the major federal household surveys that regularly provide information on health insurance an...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00544.x
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:To examine factors associated with guideline-concordant adjuvant therapy among breast cancer patients in a rural region of the United States and to present an advancement in quality-of-care assessment in the context of multiple treatments. DATA SOURCES:Chart abstraction on initial therapy received by 868 wom...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12269
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:To assess optimal activity size/mix of Connecticut local public health jurisdictions, through estimating economies of scale/scope/specialization for environmental inspections/services. DATA SOURCES/STUDY SETTING:Connecticut's 74 local health jurisdictions (LHJs) must provide environmental health services, bu...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12740
更新日期:2017-12-01 00:00:00
abstract::In a randomized trial of the effects of medical insurance on spending and the health status of the nonaged, we previously reported that patients with limited cost sharing had approximately one-third less use of medical services, similar general self-assessed health, and worse blood pressure, functional far vision, and...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
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journal_title:Health services research
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doi:10.1111/1475-6773.12857
更新日期:2018-12-01 00:00:00
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doi:10.1111/1475-6773.12426
更新日期:2016-08-01 00:00:00
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更新日期:2018-04-01 00:00:00
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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
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journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2009.00981.x
更新日期:2009-08-01 00:00:00
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journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01407.x
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVE:Building on the original taxonomy of hospital-based health systems from 20 years ago, we develop a new taxonomy to inform emerging public policy and practice developments. DATA SOURCES:The 2016 American Hospital Association's (AHA) Annual Survey; the 2016 IQVIA Healthcare Organizations and Systems (HCOS) dat...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13621
更新日期:2021-01-11 00:00:00
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journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1976-01-01 00:00:00
abstract:OBJECTIVE:To illustrate how the analysis of bimodal U-shaped distributed utilization can be modeled with beta-binomial regression, which is rarely used in health services research. DATA SOURCES/STUDY SETTING:Veterans Affairs (VA) administrative data and Medicare claims in 2001-2004 for 11,123 Medicare-eligible VA prim...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12055
更新日期:2013-10-01 00:00:00
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更新日期:2018-10-01 00:00:00
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journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2011.01280.x
更新日期:2011-10-01 00:00:00