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 cross-sectional measures of quality of diabetes care. DESIGN:Longitudinal study using institutional data on individual patient A1c level over time (October 1, 1998-September 30, 2000) with time variant and invariant covariates. SETTING:One hundred and twenty-five VHA facilities nationwide, October 1, 1998-September 30, 2000. PATIENTS:Diabetic veteran users with A1c measurement performed using National Glycosylated Hemoglobin Standardization Project certified A1c lab assay methods. EXPOSURES:Characteristics unlikely to reflect quality of care, but known to influence A1c levels, demographics, and baseline illness severity. MAIN OUTCOME MEASURE:Monthly change in A1c for average patient cared for at each facility. RESULTS:The preponderance of facilities showed monthly declines in within-patient A1c over the study period (mean change of -0.0148 A1c units per month, range -0.074 to 0.042). Individual facilities varied in their monthly change, with 105 facilities showing monthly declines (70 significant at .05 level) and 20 showing monthly increases (5 significant at .05 level). Case-mix adjustment resulted in modest changes (mean change of -0.0131 case-mix adjusted A1c units per month, range -0.079 to 0.043). Facilities were ranked from worst to best, with attached 90 percent confidence intervals. Among the bottom 10 ranked facilities, four remained within the bottom decile with 90 percent confidence. CONCLUSIONS:There is substantial variation in facility-level longitudinal changes in A1c levels. We propose that evaluation of change in A1c levels over time can be used as a new measure to reflect quality of care provided to populations of individuals with chronic disease.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Thompson W,Wang H,Xie M,Kolassa J,Rajan M,Tseng CL,Crystal S,Zhang Q,Vardi Y,Pogach L,Safford MMdoi
10.1111/j.1475-6773.2005.00439.xkeywords:
subject
Has Abstractpub_date
2005-12-01 00:00:00pages
1818-35issue
6 Pt 1eissn
0017-9124issn
1475-6773pii
HESR439journal_volume
40pub_type
杂志文章,多中心研究abstract::Two indexes are described, based on measures of administrative effectiveness and patient care effectiveness. The measures used were selected and ranked by a Delphi panel from a list of 30 measures drawn from the literature. Weights were assigned by the panel to 19 selected measures. The resulting indexes did well in a...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1976-10-01 00:00:00
abstract:BACKGROUND:Racial and ethnic disparities in health and health care have been documented; the elimination of such disparities is currently part of a national agenda. In order to meet this national objective, it is necessary that measures identify accurately the true prevalence of the construct of interest across diverse...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:10.1111/j.1475-6773.2005.00450.x
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To decompose the change in pediatric and adult dental care utilization over the last decade. DATA:2001 through 2010 Medical Expenditure Panel Survey. STUDY DESIGN:The Blinder-Oaxaca decomposition was used to explain the change in dental care utilization among adults and children. Changes in dental care util...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12130
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life-a group that accounts for more than one-quarter of Medicare's annual exp...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2004.00218.x
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:To investigate whether the interaction between individual race/ethnicity and community racial/ethnic composition is associated with health-related home care use among elderly persons in the United States. DATA SOURCES:A nationally representative sample of community-dwelling elders aged 65+ from the 2000 to 2...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2010.01135.x
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:The purpose of this study is to determine whether women who have been diagnosed with HIV utilize the same volume of medical care services as men who have been diagnosed with HIV. DATA SOURCES:This study uses data from the first wave of interviews of the AIDS Cost and Service Utilization Survey (ACSUS) conduc...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVE:Assess proxy respondent effects on health care evaluations by Medicare beneficiaries. DATA SOURCE:110,215 respondents from the nationally representative 2001 CAHPS((R)) Medicare Fee-for-Service Survey. STUDY DESIGN/DATA COLLECTION/EXTRACTION METHODS:We compare the effects of both proxy respondents and proxy...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2007.00820.x
更新日期:2008-06-01 00:00:00
abstract::Despite frequent reference to the Health Belief Model (HBM), few studies address the internal consistency (within questionnaires) or the stability across populations of scales used to measure HBM variables. As part of a 1983 Michigan statewide blood pressure survey, trained interviewers administered 32 health belief q...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1987-02-01 00:00:00
abstract:OBJECTIVES:To study the impact of eliminating cost sharing for screening mammography on mammography rates in a large Medicare Advantage (MA) health plan which in 2010 eliminated cost sharing in anticipation of the Affordable Care Act mandate. STUDY SETTING:Large MA health maintenance organization offering individual-s...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12486
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:Microsimulation was used to assess the financial impact on hospitals of a surge in influenza admissions in advance of the H1N1 pandemic in the fall of 2009. The goal was to estimate net income and losses (nationally, and by hospital type) of a response of filling unused hospital bed capacity proportionately a...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12041
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice. DATA SOURCES/STUDY SETTING:Ambulatory-based general internists in 13 states participated in the assessment. STUDY DESIGN:We assessed physician-level performance, adjuste...
journal_title:Health services research
pub_type: 杂志文章
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abstract:OBJECTIVE:To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes. STUDY SETTING:Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network. STUDY DESIGN:A retrospec...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2005.00423.x
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVE:To examine whether nurse practitioner (NP)-assigned patients exhibited differences in utilization, costs, and clinical outcomes compared to medical doctor (MD)-assigned patients. DATA SOURCES:Veterans Affairs (VA) administrative data capturing characteristics, outcomes, and provider assignments of 806 434 VA...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.13246
更新日期:2020-04-01 00:00:00
abstract::All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale ...
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:1992-02-01 00:00:00
abstract:OBJECTIVE:To quantify between-unit variability in mean length of stay (LoS) between intensive care units (ICUs) after adjusting for differences in case mix using a method that does not require arbitrary trimming of data. SETTING:An analysis of registry data from pediatric ICUs (PICUs) in Australia and New Zealand. ST...
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pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01421.x
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:To examine the influence of dimensions of service quality on patient experience of primary care. DATA SOURCES/STUDY SETTING:Data from the national GP Patient Survey in England 2014/15, with responses from 858,351 patients registered at 7,918 practices. STUDY DESIGN:Expert panel and principal component analy...
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doi:10.1111/1475-6773.12985
更新日期:2018-12-01 00:00:00
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更新日期:2012-04-01 00:00:00
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journal_title:Health services research
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1475-6773.2005.00400.x
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:This study is designed to assess the cost of services provided to Medicare beneficiaries by nurse practitioners (NPs) billing under their own National Provider Identification number as compared to primary care physicians (PCMDs). DATA SOURCE:Medicare Part A (inpatient) and Part B (office visit) claims for 20...
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更新日期:2016-08-01 00:00:00
abstract:OBJECTIVE:To test for differences in patient outcomes when hospital and post-acute care (PAC) providers participate in accountable care organizations (ACOs). DATA/SETTING:Using Medicare claims, we examined changes in readmission, Medicare spending, and length of stay among patients admitted to ACO-participating hospit...
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更新日期:2018-12-01 00:00:00
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更新日期:1993-04-01 00:00:00
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更新日期:2014-08-01 00:00:00
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更新日期:2021-01-11 00:00:00
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doi:
更新日期:1995-06-01 00:00:00
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更新日期:2015-06-01 00:00:00
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更新日期:1999-02-01 00:00:00
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更新日期:1999-04-01 00:00:00
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更新日期:2012-06-01 00:00:00
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更新日期:2004-04-01 00:00:00
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更新日期:1994-08-01 00:00:00