Cross-sectional versus longitudinal performance assessments in the management of diabetes.

Abstract:

BACKGROUND:Performance assessments help to quantify the level of adherence with practice standards and are often used to measure and compare the quality of care. However, most performance assessments are based on a cross-sectional analysis of patient information, whereas patient care is inherently longitudinal. This discordance could confound the relationship between the performance measure and the true quality of care. OBJECTIVE:The objective of this study was to illustrate differences in performance assessment as measured by a traditional cross-sectional analysis compared with a longitudinal analysis. METHODS:We conducted a cross-sectional and longitudinal analysis of a cohort of diabetic patients in an integrated delivery system having primary care visits and hemoglobin A1c (HBA1c) testing in both 1999 and 2000. RESULTS:In the cross-sectional analysis of 4661 patients, we found a modestly increasing proportion achieved an HBA1c level of <8.0%: 73.1% in 1999 and 75.6% in 2000. Longitudinal analysis, however, suggested that certain subsets of patients were more likely to switch from good to poor control or retain their level of poor control over the 2 years studied. In particular, compared with whites, blacks were 1.76 (95% confidence interval [CI], 1.31-2.37) times as likely to switch from good to poor control and only 0.56 (95% CI, 0.41-0.76) times as likely to switch from poor to good control. Patients aged 35 to 49 were 2.54 (95% CI, 1.79-3.45) times as likely to switch from good to poor and only 0.66 (95% CI, 0.47-0.94) times as likely to switch from poor to good control than patients over age 64 years. CONCLUSIONS:Cross-sectional performance assessments could mask changes in diabetes control among individuals belonging to a cohort and, conceptually, are poorer indicators of care process than longitudinal measures. In addition, longitudinal analyses suggest the influence of patient sociodemographic factors on the performance assessment that should be accounted for when comparing quality of care for diabetes.

journal_name

Med Care

journal_title

Medical care

authors

Weiner M,Long J

doi

10.1097/01.mlr.0000109167.86509.24

keywords:

subject

Has Abstract

pub_date

2004-02-01 00:00:00

pages

II34-9

issue

2 Suppl

eissn

0025-7079

issn

1537-1948

journal_volume

42

pub_type

杂志文章
  • Predictors of Multiple Emergency Department Utilization Among Frequent Emergency Department Users in 3 States.

    abstract:BACKGROUND:Research on frequent emergency department (ED) use shows that a subgroup of patients visits multiple EDs. This study characterizes these individuals. OBJECTIVE:The objective of this study was to determine how many frequent ED users seek care at multiple EDs and to identify sociodemographic, clinical, and co...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001228

    authors: Giannouchos TV,Washburn DJ,Kum HC,Sage WM,Ohsfeldt RL

    更新日期:2020-02-01 00:00:00

  • Main trends in hospital use in different cities in Japan.

    abstract::In this study, trends in hospital use were identified in Japanese cities. Data for all inpatient care in May 1985 (9,555 patients) and in May 1988 (11,205 patients) paid for by National Health Insurance in 12 cities in Osaka Prefecture were analyzed. The main factor affecting differences in inpatient days per insured ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199304000-00005

    authors: Tatara K,Shinsho F,Nishigaki C,Takatorige T,Okamoto E,Kuroda K

    更新日期:1993-04-01 00:00:00

  • Does utilization review reduce unnecessary hospital care and contain costs?

    abstract::Research indicates that approximately one in five hospital admissions is unnecessary or inappropriate, based on accepted clinical criteria. Various cost-containment approaches have been initiated to reduce unnecessary hospital care. Among these approaches, hospital utilization review (UR) has shown promise as a cost-c...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198906000-00006

    authors: Wickizer TM,Wheeler JR,Feldstein PJ

    更新日期:1989-06-01 00:00:00

  • Associations between health status and utilities implications for policy.

    abstract:BACKGROUND:If shape of a person's utility function is associated with his health status, as is predicted by Prospect Theory, the use of utilities from the healthy could result in 'de facto' discrimination against the sick. OBJECTIVES:To determine if patients' utilities for hypothetical states and for their current hea...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199905000-00007

    authors: Lenert LA,Treadwell JR,Schwartz CE

    更新日期:1999-05-01 00:00:00

  • Organizational predictors of adherence to ambulatory care screening guidelines.

    abstract:OBJECTIVE:The purpose of this study was to identify hospital organizational characteristics consistently associated with adherence to multiple clinical practice guidelines (CPGs). We examined the relationship between organizational and patient population characteristics and adherence to three screening CPGs implemented...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200212000-00005

    authors: Vaughn TE,McCoy KD,BootsMiller BJ,Woolson RF,Sorofman B,Tripp-Reimer T,Perlin J,Doebbeling BN

    更新日期:2002-12-01 00:00:00

  • Language concordance as a determinant of patient compliance and emergency room use in patients with asthma.

    abstract::To test the hypothesis that the ability of physicians to speak the same language as asthmatic patients promotes patient compliance and the use of scheduled office appointments in preference to emergency services, the charts of 96 Spanish-speaking patients with asthma were reviewed. Of these patients, 65 were cared for...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198812000-00003

    authors: Manson A

    更新日期:1988-12-01 00:00:00

  • Improving adherence to screening follow-up among women with abnormal Pap smears: results from a large clinic-based trial of three intervention strategies.

    abstract::In a large randomized trial involving over 2,000 women with abnormal cervical cytology (pap smear), three clinic-based interventions were tested as strategies to increase return rates for screening follow-up: 1) a personalized follow-up letter and pamphlet; 2) a slide-tape program on pap smears; and 3) transportation ...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-199203000-00004

    authors: Marcus AC,Crane LA,Kaplan CP,Reading AE,Savage E,Gunning J,Bernstein G,Berek JS

    更新日期:1992-03-01 00:00:00

  • Impact of Medicare's Nonpayment Program on Hospital-acquired Conditions.

    abstract:BACKGROUND:Medicare's Nonpayment Program of 2008 (hereafter called Program) withholds hospital reimbursement for costs related to hospital-acquired conditions (HACs). Little is known whether a hospital's Medicare patient load [quantified by the hospital's Medicare utilization ratio (MUR), which is the proportion of inp...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000680

    authors: Thirukumaran CP,Glance LG,Temkin-Greener H,Rosenthal MB,Li Y

    更新日期:2017-05-01 00:00:00

  • Changing provider behavior: an overview of systematic reviews of interventions.

    abstract:BACKGROUND:Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not eas...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Grimshaw JM,Shirran L,Thomas R,Mowatt G,Fraser C,Bero L,Grilli R,Harvey E,Oxman A,O'Brien MA

    更新日期:2001-08-01 00:00:00

  • After-hours telephone access to physicians with access to computerized medical records. Experience in an inner-city general medicine clinic.

    abstract::The authors examined the effect of after-hours telephone access to physicians and physician access to computerized medical records on hospitalizations and emergency room (ER) visits in an inner-city, adult, general medicine clinic. Patients were randomly assigned to a control (C) and two study groups (S1 and S2). Pati...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00005650-198501000-00003

    authors: Darnell JC,Hiner SL,Neill PJ,Mamlin JJ,McDonald CJ,Hui SL,Tierney WM

    更新日期:1985-01-01 00:00:00

  • Effect of increased copayments on pharmacy use in the Department of Veterans Affairs.

    abstract:OBJECTIVES:In February 2002, the Department of Veterans Affairs (VA) raised medication copayments from $2 to $7 per 30-day supply of medication for certain veteran groups. We examined the impact of the copayment increase on medication acquisition from VA. METHODS:This was a retrospective cohort study using data from n...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3180ca95be

    authors: Stroupe KT,Smith BM,Lee TA,Tarlov E,Durazo-Arvizu R,Huo Z,Barnett T,Cao L,Burk M,Cunningham F,Hynes DM,Weiss KB

    更新日期:2007-11-01 00:00:00

  • Association of physician and hospital volume with use of aspirin and reperfusion therapy in acute myocardial infarction.

    abstract:BACKGROUND:The association between volume of patients treated and quality of care has important implications for patient referral policies and approaches to quality improvement. Most studies have focused on hospital volume alone and health outcomes. OBJECTIVES:The objective of this work was to examine the association ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200011000-00004

    authors: Willison DJ,Soumerai SB,Palmer RH

    更新日期:2000-11-01 00:00:00

  • The dynamics of health insurance among the near elderly.

    abstract::Data from the Longitudinal Survey of Income and Program Participation were used to examine the dynamics of health insurance among persons 55 to 64 years of age. Persons in this age range are especially vulnerable to incurring high health care costs. Between the summer of 1983 and early 1986, 21% of persons 55 to 64 ye...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199207000-00003

    authors: Jensen GA

    更新日期:1992-07-01 00:00:00

  • Comorbidity-adjusted complication risk: a new outcome quality measure.

    abstract::The measurement of inpatient complications his received substantial attention in recent years because mortality rates and other outcome measures often appear unable to discriminate superior from inferior hospital care. Complication measurement holds out the promise of being more sensitive to variations in patient care...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199605000-00010

    authors: Brailer DJ,Kroch E,Pauly MV,Huang J

    更新日期:1996-05-01 00:00:00

  • The Self-Adapting Focused Review System. Probability sampling of medical records to monitor utilization and quality of care.

    abstract::Medical record review is increasing in importance as the need to identify and monitor utilization and quality of care problems grow. To conserve resources, reviews are usually performed on a subset of cases. If judgment is used to identify subgroups for review, this raises the following questions: How should subgroups...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:

    authors: Ash A,Schwartz M,Payne SM,Restuccia JD

    更新日期:1990-11-01 00:00:00

  • Ambulatory care sensitive hospitalizations and emergency visits: experiences of Medicaid patients using federally qualified health centers.

    abstract:BACKGROUND:Federally Qualified Health Centers (FQHCs) serve as regular sources of preventive and primary care for low-income families within their communities and are key parts of the health care safety net. OBJECTIVES:Compare admissions and emergency room visits for ambulatory care sensitive conditions (ACSCs) among ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200106000-00004

    authors: Falik M,Needleman J,Wells BL,Korb J

    更新日期:2001-06-01 00:00:00

  • Time utilization of a population of general surgeons in a prepaid group practice.

    abstract::Seven general surgeons in a prepaid group practice previously shown to have a mean operative work load of 9.2 hernia equivalents (HE) per week were found to have a standardized mean daytime working week of 56.2 hours, exclusive of evening activities of which 50.7 hours were devoted to professional activities. The surg...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197610000-00003

    authors: Watkins RN,Hughes EF,Lewit EM

    更新日期:1976-10-01 00:00:00

  • Sequelae of an Evidence-based Approach to Management for Access to Care in the Veterans Health Administration.

    abstract:BACKGROUND:Access to health care is a critical concept in the design, delivery, and evaluation of high quality care. Meaningful evaluation of access requires research evidence and the integration of perspectives of patients, providers, and administrators. OBJECTIVE:Because of high-profile access challenges, the Depart...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001177

    authors: Kaboli PJ,Miake-Lye IM,Ruser C,Yano EM,Orshansky G,Rubenstein L,Curtis I,Kirsh S,Hempel S

    更新日期:2019-10-01 00:00:00

  • Effects of cost-containment strategies within managed care on continuity of the relationship between patients with depression and their primary care providers.

    abstract:BACKGROUND:Continuity of the relationship between patients and primary care providers (PCPs) is an important component of care from the consumer perspective that may be affected by variation in cost containment strategies within managed care. OBJECTIVE:To evaluate the effects of cost containment strategies on the cont...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200110000-00005

    authors: Meredith LS,Sturm R,Camp P,Wells KB

    更新日期:2001-10-01 00:00:00

  • Evaluation of centers of excellence program for knee and hip replacement.

    abstract:BACKGROUND:Medicare and private plans are encouraging individuals to seek care at hospitals that are designated as centers of excellence. Few evaluations of such programs have been conducted. This study examines a large national initiative that designated hospitals as centers of excellence for knee and hip replacement....

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182699407

    authors: Mehrotra A,Sloss EM,Hussey PS,Adams JL,Lovejoy S,Soohoo NF

    更新日期:2013-01-01 00:00:00

  • The quality of cost data. A caution from the Department of Veterans Affairs experience.

    abstract::Many health care system, including that of the Department of Veterans Affairs (VA), are facing dramatic changes as they adapt to state-level reform legislation and move into managed care environments. As new costing systems are designed and as researchers seek to conduct cost-effectiveness studies to guide health poli...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199603001-00008

    authors: Swindle RW Jr,Beattie MC,Barnett PG

    更新日期:1996-03-01 00:00:00

  • Persistent medication affordability problems among disabled Medicare beneficiaries after Part D, 2006-2011.

    abstract:BACKGROUND:Disabled Americans who qualify for Medicare coverage typically have multiple chronic conditions, are highly dependent on effective drug therapy, and have limited financial resources, putting them at risk for cost-related medication nonadherence (CRN). Since 2006, the Part D benefit has helped Medicare benefi...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000205

    authors: Naci H,Soumerai SB,Ross-Degnan D,Zhang F,Briesacher BA,Gurwitz JH,Madden JM

    更新日期:2014-11-01 00:00:00

  • Health care utilization: the effect of extending insurance to adults on Medicaid or uninsured.

    abstract::Current health care system reform proposals center on reducing the number of uninsured by extending private health insurance coverage. Discussion has also included enrolling Medicaid recipients in private programs. Much of the deliberation concerning extending coverage has centered on cost, but largely has not address...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199403000-00004

    authors: Hahn B

    更新日期:1994-03-01 00:00:00

  • Defining Multiple Chronic Conditions for Quality Measurement.

    abstract:BACKGROUND/OBJECTIVE:Patients with multiple chronic conditions (MCCs) are a critical but undefined group for quality measurement. We present a generally applicable systematic approach to defining an MCC cohort of Medicare fee-for-service beneficiaries that we developed for a national quality measure, risk-standardized ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000853

    authors: Drye EE,Altaf FK,Lipska KJ,Spatz ES,Montague JA,Bao H,Parzynski CS,Ross JS,Bernheim SM,Krumholz HM,Lin Z

    更新日期:2018-02-01 00:00:00

  • The intellectual decline of the health care left.

    abstract::The health care left-a traditional source of critique and reform-has become intellectually less competent and politically less effective in carrying out its historic role in the continuing great debate over health policies and programs. Its credibility has diminished in recent years as it has come to operate on a seri...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198009000-00007

    authors: Bellin LE

    更新日期:1980-09-01 00:00:00

  • Physician attitudes and experience regarding the care of patients with acquired immunodeficiency syndrome (AIDS) and related disorders (ARC).

    abstract::The number of patients with acquired immunodeficiency syndrome (AIDS) continues to increase. These patients require medical care from physicians who are well trained and who are willing to provide that care. In 1985, we undertook a survey of 314 heterosexual and homosexual physicians in Los Angeles County to determine...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198708000-00001

    authors: Richardson JL,Lochner T,McGuigan K,Levine AM

    更新日期:1987-08-01 00:00:00

  • Performance evaluations and league tables: do they capture variation between organizational units? An analysis of 5 Swedish pharmacological performance indicators.

    abstract:BACKGROUND:The use of league tables during the last decade has frequently been employed to assess quality in health care. However, few studies have attempted to assess quality by quantifying the variability across the organizational units or attempted to investigate whether the units are the correct context that really...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e31820325c5

    authors: Ohlsson H,Librero J,Sundquist J,Sundquist K,Merlo J

    更新日期:2011-03-01 00:00:00

  • Designing and implementing research on a statewide quality improvement initiative: the DIAMOND study and initiative.

    abstract:OBJECTIVE:To demonstrate a rigorous methodology that optimally balanced internal validity with generalizability to evaluate a statewide collaborative that implemented an evidence-based, collaborative care model for depression management in primary care. STUDY DESIGN AND SETTING:Several operational features of the DIAM...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318249d8a4

    authors: Crain AL,Solberg LI,Unützer J,Ohnsorg KA,Maciosek MV,Whitebird RR,Beck A,Molitor BA

    更新日期:2013-09-01 00:00:00

  • Assessing patient safety in the United States: challenges and opportunities.

    abstract:BACKGROUND:In 1999, the US Congress mandated the Agency for Healthcare Research and Quality (AHRQ), Department of Health and Human Services (DHHS), to report annually to the nation about healthcare quality. One chapter in the National Healthcare Quality Report (NHQR) is focused on patient safety. OBJECTIVES:The object...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/00005650-200503001-00007

    authors: Zhan C,Kelley E,Yang HP,Keyes M,Battles J,Borotkanics RJ,Stryer D

    更新日期:2005-03-01 00:00:00

  • The effect of medicare health maintenance organizations on hospitalization rates for ambulatory care-sensitive conditions.

    abstract:OBJECTIVE:The objective of this study was to estimate the effect of Medicare Health Maintenance Organization (HMO) enrollment on hospitalization rates and total inpatient days for ambulatory care-sensitive conditions (ACSCs) after controlling for selection. RESEARCH DESIGN:Simultaneous equations using a discrete facto...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000220699.58684.68

    authors: Zeng F,O'Leary JF,Sloss EM,Lopez MS,Dhanani N,Melnick G

    更新日期:2006-10-01 00:00:00