Abstract：
OBJECTIVE:To examine the effect of hospital volume on 30-day mortality for patients with congestive heart failure (CHF) using administrative and clinical data in conventional regression and instrumental variables (IV) estimation models. DATA SOURCES:The primary data consisted of longitudinal information on comorbid conditions, vital signs, clinical status, and laboratory test results for 21,555 Medicare-insured patients aged 65 years and older hospitalized for CHF in northeast Ohio in 1991-1997. STUDY DESIGN:The patient was the primary unit of analysis. We fit a linear probability model to the data to assess the effects of hospital volume on patient mortality within 30 days of admission. Both administrative and clinical data elements were included for risk adjustment. Linear distances between patients and hospitals were used to construct the instrument, which was then used to assess the endogeneity of hospital volume. PRINCIPAL FINDINGS:When only administrative data elements were included in the risk adjustment model, the estimated volume-outcome effect was statistically significant (p=.029) but small in magnitude. The estimate was markedly attenuated in magnitude and statistical significance when clinical data were added to the model as risk adjusters (p=.39). IV estimation shifted the estimate in a direction consistent with selective referral, but we were unable to reject the consistency of the linear probability estimates. CONCLUSIONS:Use of only administrative data for volume-outcomes research may generate spurious findings. The IV analysis further suggests that conventional estimates of the volume-outcome relationship may be contaminated by selective referral effects. Taken together, our results suggest that efforts to concentrate hospital-based CHF care in high-volume hospitals may not reduce mortality among elderly patients.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Tsai AC,Votruba M,Bridges JF,Cebul RDdoi
10.1111/j.1475-6773.2005.00461.xkeywords:
subject
Has Abstractpub_date
2006-02-01 00:00:00pages
252-64issue
1eissn
0017-9124issn
1475-6773pii
HESR461journal_volume
41pub_type
杂志文章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 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 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: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：OBJECTIVE:To summarize the state of the art in quality improvement, review its application to care for children, and define the information that will be needed so that care for children can be further improved. PRINCIPAL FINDINGS:Health services for children exhibit numerous deficiencies in quality of care. The defici...
journal_title：Health services research
pub_type： 杂志文章,评审
doi：
更新日期：1998-10-01 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：:Over a two-year interval, computerized tomography (CT) scans at an urban, 400-bed Department of Veterans Affairs medical center (VAMC) were obtained in three ways. First, an in-house low-efficiency machine was used. Then, scans were done at another area hospital, in effect duplicating some aspects of regionalizing ser...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1990-04-01 00:00:00
abstract：:The planning, budgeting, and controlling processes (PBCP) largely subsume all of the planning and controlling activities of an organization. This paper discusses these activities within the context of a single management control system, focusing on three topics. First, a brief historical perspective of management conc...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1979-07-01 00:00:00
abstract：OBJECTIVE:To develop and validate a disease-specific automated inpatient mortality risk adjustment system primarily using computerized numerical laboratory data and supplementing them with administrative data. To assess the values of additional manually abstracted data. METHODS:Using 1,271,663 discharges in 2000-2001,...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2010.01126.x
更新日期：2010-12-01 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：OBJECTIVE:To use statistical process control charts to monitor in-hospital outcomes at the hospital level for a wide range of procedures and diagnoses. DATA SOURCES:Routine English hospital admissions data. STUDY DESIGN:Retrospective analysis using risk-adjusted log-likelihood cumulative sum (CUSUM) charts, comparing...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2007.00742.x
更新日期：2008-02-01 00:00:00
abstract：:The purpose of this study was to evaluate the applicability of a multiattribute utility model for measuring the severity of a patient's illness. A single medical problem (an analysis of the costs and benefits of different burn care systems) was used to test the model. Physicians estimated the relative importance of an...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1975-04-01 00:00:00
abstract：:This article examines factors related to hospital closures, using a longitudinal sample of surviving and closed hospitals. The hospitals are drawn from three states with different regulatory programs. Size of hospital and occupancy rate are shown to be related to likelihood of closure, while ownership, length of stay,...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1983-01-01 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 examine facility variation in data quality of the level of pain documented in the minimum data set (MDS) as a function of level of hospice enrollment in nursing homes (NHs). DATA SOURCE:Clinical assessments on 3,469 nonhospice residents from 178 NHs were merged with On-line Survey Certification and Report...
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：BACKGROUND:Many states have passed legislation mandating that health plans provide direct access to obstetricians/gynecologists (hereinafter "ob/gyns") for women, limiting the ability of plans to require referrals or otherwise restrict access. One benefit of these laws may be improved preventive screening rates, but no...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2006.00646.x
更新日期：2007-06-01 00:00:00
abstract：:Mr. Zamberlan is one of seven major executives in the Department of Veterans Affairs (VA) Veterans Health Services and Research Administration (VHS&RA), directing health care in a five-state region that includes 21 medical centers, 7 outpatient clinics, and 19 veterans outreach centers. As a medical center director in...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1990-04-01 00:00:00
abstract：OBJECTIVE:To describe differences in patient experiences of hospital care by preferred language within racial/ethnic groups. DATA SOURCE:2014-2015 HCAHPS survey data. STUDY DESIGN:We compared six composite measures for seven languages (English, Spanish, Russian, Portuguese, Chinese, Vietnamese, and Other) within appl...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13105
更新日期：2019-02-01 00:00:00
abstract：OBJECTIVE:To evaluate the impact of health professionals' intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. STUDY SETTING:Forty-six community pharmacies and 50...
journal_title：Health services research
pub_type： 杂志文章,随机对照试验
doi：10.1111/1475-6773.13152
更新日期：2019-06-01 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...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12425
更新日期：2016-08-01 00:00:00
abstract：OBJECTIVE:To assess the issue of nonrepresentative sampling in Medicare Advantage (MA) risk adjustment. DATA SOURCES:Medicare enrollment and claims data from 2008 to 2011. DATA EXTRACTION:Risk adjustment predictor variables were created from 2008 to 2010 Part A and B claims and the Medicare Beneficiary Summary File. ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13046
更新日期：2018-12-01 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：:This paper addresses two questions: (1) Does adjusting for case mix have any effect on prospective admission-based reimbursement? and (2) How does the way in which case type is defined (DRG, ICD9CM, Age, etc) affect reimbursement systems? Data from 20 Maryland hospitals provided the basis for analysis, and the results...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1983-07-01 00:00:00
abstract：OBJECTIVE:To examine the relationship of services for post-acute care (PAC) to stroke patient outcomes. DATA SOURCES/STUDY SETTING:Veterans Health Administration (VHA) hospitals from two facility-level surveys and extant data files. STUDY DESIGN:Cross-sectional study of veterans hospitalized with acute stroke during ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-02-01 00:00:00
abstract：OBJECTIVE:To determine whether difficulty walking and the strategies persons use to compensate for this deficit influenced downstream Medicare expenditures. DATA SOURCE:Secondary data analysis of Medicare claims data (1999-2000) for age-eligible Medicare beneficiaries (N=4,997) responding to the community portion of t...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2006.00509.x
更新日期：2006-06-01 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 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：:We examined the expansion of Veterans Administration (now Department of Veterans Affairs--VA) inpatient psychiatric services from 1963 to 1984. Aggregate national trends in VA inpatient episodes between 1963 and 1984 document not only increased use of inpatient services but also "decentralization," or a shift to provi...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1990-04-01 00:00:00
abstract：OBJECTIVE:To assess the effect of dissemination and implementation of an intervention consisting of practice facilitation and a risk-stratified, population management dashboard on cardiovascular risk reduction for patients at high risk in small, primary care practices. STUDY SETTING:A total of 219 small primary care p...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13571
更新日期：2020-12-01 00:00:00
abstract：:Cost-benefit analyses are routinely included in evaluations of acute care programs. In the case of long-term care, it is frequently alleged that cost-benefit analysis cannot be fruitfully applied. This article demonstrates the utility of applying cost-benefit analysis to evaluations of long-term care programs. A case ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1981-04-01 00:00:00
