Substance abuse treatment duration for Medicaid versus commercial clients in a health maintenance organization.

Abstract:

BACKGROUND:As Medicaid clients have come to be enrolled in managed care, concerns have arisen about the ability of private sector systems to meet the needs of enrollees with substance abuse problems. OBJECTIVES:This project describes treatment initiation and duration for Medicaid and commercial substance abuse treatment clients in a large health maintenance organization (HMO). RESEARCH DESIGN:This study was a prospective secondary analysis of information from HMO databases. Subjects were 641 adult Medicaid clients who contacted the HMO's addiction medicine department in 1996 or 1997 and commercial HMO addiction medicine patients (n=447). First contact with addiction medicine during the study period was the index event. MEASURES:Chief dependent variables were initiation and duration of substance abuse treatment after the index event. RESULTS:Logistic regression showed that longer HMO enrollment predicted treatment initiation after substance abuse assessment, but Medicaid status was not a significant predictor. A competing risks analysis using Cox proportional hazards models indicated that once subjects had initiated, Medicaid was not significantly related to exit from substance abuse treatment. Analysis of health plan disenrollment by Medicaid clients indicated that the most common reason was loss of Medicaid eligibility. CONCLUSIONS:These results raise the possibility that state Medicaid policies may make it difficult for clients to obtain suitable chemical dependency treatment services.

journal_name

Med Care

journal_title

Medical care

authors

McFarland BH,Lynch FL,Freeborn DK,Green CA,Polen MR,Deck DD,Dickinson DM

doi

10.1097/01.mlr.0000215814.01127.ce

subject

Has Abstract

pub_date

2006-06-01 00:00:00

pages

601-6

issue

6

eissn

0025-7079

issn

1537-1948

pii

00005650-200606000-00016

journal_volume

44

pub_type

杂志文章
  • The effects of social characteristics on the utilization of preventive medical services in contrasting health care programs.

    abstract::This study, based on household interviews of employed individuals and their families, examines the effects of type of health insurance program and various sociodemographic factors on patterns of use of preventive medical services. A major concern of the paper is to explore the issue of whether participants in prepaid ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197605000-00002

    authors: Slesinger DP,Tessler RC,Mechanic D

    更新日期:1976-05-01 00:00:00

  • Measuring physician job satisfaction in a changing workplace and a challenging environment. SGIM Career Satisfaction Study Group. Society of General Internal Medicine.

    abstract:BACKGROUND:Changes in the demographic, specialty, and employment sector composition of medicine have altered physicians' jobs, limiting autonomy and reducing morale. Because physician job satisfaction has been linked to clinical variables, better measurement might help to ameliorate conditions linked to medical disaffe...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199911000-00010

    authors: Konrad TR,Williams ES,Linzer M,McMurray J,Pathman DE,Gerrity M,Schwartz MD,Scheckler WE,Van Kirk J,Rhodes E,Douglas J

    更新日期:1999-11-01 00:00:00

  • Travel time and attrition from VHA care among women veterans: how far is too far?

    abstract:BACKGROUND:Travel time, an access barrier, may contribute to attrition of women veterans from Veterans Health Administration (VHA) care. OBJECTIVE:We examined whether travel time influences attrition: (a) among women veterans overall, (b) among new versus established patients, and (c) among rural versus urban patients...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000296

    authors: Friedman SA,Frayne SM,Berg E,Hamilton AB,Washington DL,Saechao F,Maisel NC,Lin JY,Hoggatt KJ,Phibbs CS

    更新日期:2015-04-01 00:00:00

  • Characterizing patient dysfunction in Alzheimer's-type dementia.

    abstract::Although Alzheimer's-type dementia (ATD) is characterized by global intellectual deterioration, few systematic efforts have been made to characterize overall dysfunction of ATD patients. The Sickness Impact Profile (SIP) was administered to ATD patients and family members to determine the concurrent validity of family...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198805000-00002

    authors: Krenz C,Larson EB,Buchner DM,Canfield CG

    更新日期:1988-05-01 00:00:00

  • A prospective study of 2,000 patients attending a chiropractic college teaching clinic.

    abstract::A prospective study was undertaken to characterize 2,000 patients attending a chiropractic teaching clinic and the effectiveness of the care they received. Fifty-two percent of the patients were between 21 and 34 years old; 41% categorized their occupation as professional and 14% as skilled blue collar; 79% presented ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198706000-00006

    authors: Nyiendo J,Haldeman S

    更新日期:1987-06-01 00:00:00

  • Practice variation and the risk of low birth weight in a public prenatal care program.

    abstract:OBJECTIVES:Use of antepartum tests of fetal well-being is widespread even though effectiveness in preventing fetal damage or stillbirth has not been established. The study objective was to examine whether aggressive use of these tests might contribute to increased rates of other birth outcomes, including low birth weig...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199701000-00002

    authors: Helfand M,Zimmer-Gembeck MJ

    更新日期:1997-01-01 00:00:00

  • The rural health care workforce implications of practice guideline implementation.

    abstract:BACKGROUND:Rural health care workforce forecasting has not included adjustments for predictable changes in practice patterns, such as the introduction of practice guidelines. PURPOSE:To estimate the impact of a practice guideline for a single health condition on the needs of a rural health professional workforce. MET...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199903000-00006

    authors: Yawn BP,Casey M,Hebert P

    更新日期:1999-03-01 00:00:00

  • Prevalence and predictors of unmet need for supportive services among HIV-infected persons: impact of case management.

    abstract:BACKGROUND:Previous research has indicated that the needs of persons infected with human immunodeficiency virus (HIV) for supportive services often go unmet. Although case management has been advocated as a method of decreasing unmet needs for supportive services, its effectiveness is poorly understood. OBJECTIVES:To ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200001000-00007

    authors: Katz MH,Cunningham WE,Mor V,Andersen RM,Kellogg T,Zierler S,Crystal SC,Stein MD,Cylar K,Bozzette SA,Shapiro MF

    更新日期:2000-01-01 00:00:00

  • Improving risk adjustment for Medicare capitated reimbursement using nonlinear models.

    abstract:OBJECTIVES:This article compares a linear risk-adjusted model of medical expenditures for Medicare patients with a model that explicitly account for skewness in distribution of expenditures. METHODS:A model of expenditures and a model of the square root of expenditures, each expressed as linear combinations of risk ad...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.MLR.0000065127.88685.7D

    authors: Veazie PJ,Manning WG,Kane RL

    更新日期:2003-06-01 00:00:00

  • Understanding the challenges of adjuvant treatment measurement and reporting in breast cancer: cancer treatment measuring and reporting.

    abstract:BACKGROUND:Healthcare accrediting organizations and insurers increasingly require reporting of clinical data, and cancer treatment is one area of enhanced scrutiny. OBJECTIVES:To compare rates of received versus reported adjuvant breast cancer treatments, and to assess barriers to measuring and reporting treatments to...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e3182422f7b

    authors: Bickell NA,McAlearney AS,Wellner J,Fei K,Franco R

    更新日期:2013-06-01 00:00:00

  • A Detailed Exploration Into the Association of Prescribed Opioid Dosage and Overdose Deaths Among Patients With Chronic Pain.

    abstract:BACKGROUND:High opioid dosage has been associated with overdose, and clinical guidelines have cautioned against escalating dosages above 100 morphine-equivalent mg (MEM) based on the potential harm and the absence of evidence of benefit from high dosages. However, this 100 MEM threshold was chosen somewhat arbitrarily....

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000505

    authors: Bohnert AS,Logan JE,Ganoczy D,Dowell D

    更新日期:2016-05-01 00:00:00

  • Measuring teamwork in health care settings: a review of survey instruments.

    abstract:BACKGROUND:Teamwork in health care settings is widely recognized as an important factor in providing high-quality patient care. However, the behaviors that comprise effective teamwork, the organizational factors that support teamwork, and the relationship between teamwork and patient outcomes remain empirical questions...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/MLR.0b013e31827feef6

    authors: Valentine MA,Nembhard IM,Edmondson AC

    更新日期:2015-04-01 00:00:00

  • A comparison of four indirect methods of assessing utility values in rheumatoid arthritis.

    abstract:OBJECTIVES:Utility scores can be assessed indirectly using preference-based instruments and used as weightings for quality-adjusted life years in economic analyses. It is not clear whether available instruments yield similar results or what domains of health are contributing to the overall score in a sample of patients...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200411000-00012

    authors: Marra CA,Esdaile JM,Guh D,Kopec JA,Brazier JE,Koehler BE,Chalmers A,Anis AH

    更新日期:2004-11-01 00:00:00

  • Review of methods to determine VA health care costs.

    abstract:BACKGROUND:Estimates of health care cost are needed to conduct cost-effectiveness research at the facilities operated by the US Department of Veterans Affairs. METHODS:The medical literature was searched for VA studies to characterize different cost methods and identify their advantages and disadvantages. RESULTS:Dif...

    journal_title:Medical care

    pub_type: 杂志文章,评审

    doi:10.1097/00005650-199904002-00003

    authors: Barnett PG

    更新日期:1999-04-01 00:00:00

  • Can administrative data be used to compare postoperative complication rates across hospitals?

    abstract:BACKGROUND:Several quality assessment systems use administrative data to identify postoperative complications, with uncertain validity. OBJECTIVES:To determine how accurately postoperative complications are reported in administrative data, whether accuracy varies systematically across hospitals, and whether serious co...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-200210000-00004

    authors: Romano PS,Chan BK,Schembri ME,Rainwater JA

    更新日期:2002-10-01 00:00:00

  • Pathways to psychotropic drugs. Understanding the basis of gender differences.

    abstract::Earlier studies have established substantial gender differences in the likelihood of obtaining a psychotropic drug prescription, and a correlation, especially among women, with such family characteristics as family responsibilities, marital separation, divorce or widowhood, and the presence of family stressors such as...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199004000-00001

    authors: Cafferata GL,Meyers SM

    更新日期:1990-04-01 00:00:00

  • Accuracy of Medicare claims data for estimation of cancer incidence and resection rates among elderly Americans.

    abstract::To explore the reliability of Medicare Part A claims data for clinical and health services research related to the care of patients with cancer, the authors compared estimates of the incidence of and resection rates for cancer of the breast, colon, and lung derived from analysis of Medicare Part A data versus data fro...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199112000-00005

    authors: Whittle J,Steinberg EP,Anderson GF,Herbert R

    更新日期:1991-12-01 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

  • 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

  • Nonresponse bias in a survey of patient perceptions of hospital care.

    abstract:BACKGROUND:Incomplete participation is of particular concern for surveys of patient perceptions of care because patients who have negative opinions may be least likely to participate. OBJECTIVE:We sought to examine indirect evidence of nonresponse bias. DESIGN:We re-analyzed data from a cross-sectional patient survey...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/01.mlr.0000156856.36901.40

    authors: Perneger TV,Chamot E,Bovier PA

    更新日期:2005-04-01 00:00:00

  • The importance of sense of community on people's perceptions of their health-care experiences.

    abstract:OBJECTIVES:The authors study the relationship between people's sense of community and problems they experience with the health-care system, specifically problems related to cost, access, provider choice, and satisfaction. METHODS:Data from a 1993 Florida poll (n = 1202) was used to conduct a multinomial logit analysis...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199609000-00004

    authors: Ahern MM,Hendryx MS,Siddharthan K

    更新日期:1996-09-01 00:00:00

  • Access to and utilization of health care by subgroups of Latino children.

    abstract:BACKGROUND:Latinos make up the largest group of minority children in the United States. Despite great diversity among Latino children, studies have traditionally treated them as a monolithic group. Few studies have examined patterns and determinants of access to and use of health care for different subgroups of Latino ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318190d9e4

    authors: Perez VH,Fang H,Inkelas M,Kuo AA,Ortega AN

    更新日期:2009-06-01 00:00:00

  • Use of the SF-36v2 Health Survey as a Screen for Risk of Major Depressive Disorder in a US Population-based Sample and Subgroup With Chronic Pain.

    abstract:STUDY OBJECTIVES:To assess the feasibility of using the SF-36v2 mental health (MH) and mental component summary (MCS) scores for classification of risk for major depressive disorder (MDD), and to determine cut-off scores based on the sensitivity and specificity in a general US representative sample, and a chronic pain ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000000617

    authors: Bell JA,daCosta DiBonaventura M,Witt EA,Ben-Joseph R,Reeve BB

    更新日期:2017-02-01 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

  • Medical and psychiatric determinants of outpatient medical utilization.

    abstract::Ninety-two general medical outpatients were surveyed with an interview, questionnaires, and a medical record review to investigate the relationships among psychiatric disorder (depression and hypochondriasis), somatic symptoms, medical morbidity, and the utilization of ambulatory medical services. Medical utilization ...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198606000-00009

    authors: Barsky AJ,Wyshak G,Klerman GL

    更新日期:1986-06-01 00:00:00

  • Potential safety gaps in order entry and automated drug alerts: a nationwide survey of VA physician self-reported practices with computerized order entry.

    abstract:OBJECTIVE:Understanding provider perceptions of and experiences with order entry and order checks (drug alerts) in an electronic prescribing system may help improve medication safety technology. DESIGN:Cross-sectional, national survey of Veterans Administration physicians practicing in various specialties. MEASUREMEN...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0b013e318222a6f5

    authors: Spina JR,Glassman PA,Simon B,Lanto A,Lee M,Cunningham F,Good CB

    更新日期:2011-10-01 00:00:00

  • An Economic Analysis of the Implementation of Team-based Collaborative Care in Outpatient General Mental Health Clinics.

    abstract:BACKGROUND:Collaborative Chronic Care Models represent an evidence-based way to structure care for chronic conditions, including mental health conditions. Few studies, however, have examined the cost implications of collaborative care for mental health. OBJECTIVE:We aimed to conduct an economic analysis of implementin...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/MLR.0000000000001372

    authors: Miller CJ,Griffith KN,Stolzmann K,Kim B,Connolly SL,Bauer MS

    更新日期:2020-10-01 00:00:00

  • Health care utilization and costs in a Medicare population by fall status.

    abstract:OBJECTIVES:The economic impact of trauma in older persons is a matter of increasing concern to public health practitioners and planners, yet it is an issue that has not been widely studied. Available evidence does suggest, however, that falls are the costliest category of injury among older persons. METHODS:This study...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-199808000-00006

    authors: Rizzo JA,Friedkin R,Williams CS,Nabors J,Acampora D,Tinetti ME

    更新日期:1998-08-01 00:00:00

  • Format review: evaluating implementation of the problem-oriented medical record.

    abstract::As interest in the problem-oriented medical record (POMR) develops, and more medical settings begin to implement the system, many observers are expressing a desire to know how well the system is being used and accepted. Moreover, settings currently using the POMR system have a need to document the effectiveness of the...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-197610000-00006

    authors: Hammett WH,Sandlow LJ,Bashook PG

    更新日期:1976-10-01 00:00:00

  • Nosocomial infection rates as an indicator of quality.

    abstract::An interest in using nosocomial infection rates as an outcome measure to reflect quality of care in hospitals prompted us to consider factors in addition to quality that influence these rates. Approximately one third of nosocomial infections are potentially preventable, and changes in this "preventable" stratum of inf...

    journal_title:Medical care

    pub_type: 杂志文章

    doi:10.1097/00005650-198807000-00003

    authors: Larson E,Oram LF,Hedrick E

    更新日期:1988-07-01 00:00:00