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. RESEARCH DESIGN:This retrospective cohort study used logistic regression to estimate the association between drive time and attrition, overall and for new/established and rural/urban patients. SUBJECTS:In total, 266,301 women veteran VHA outpatients in the Fiscal year 2009. MEASURES:An "attriter" did not return for VHA care during the second through third years after her first 2009 visit (T0). Drive time (log minutes) was between the patient's residence and her regular source of VHA care. "New" patients had no VHA visits within 3 years before T0. Models included age, service-connected disability, health status, and utilization as covariates. RESULTS:Overall, longer drive times were associated with higher odds of attrition: drive time adjusted odds ratio=1.11 (99% confidence interval, 1.09-1.14). The relationship between drive time and attrition was stronger among new patients but was not modified by rurality. CONCLUSIONS:Attrition among women veterans is sensitive to longer drive time. Linking new patients to VHA services designed to reduce distance barriers (telemedicine, community-based clinics, mobile clinics) may reduce attrition among women new to VHA.
journal_name
Med Carejournal_title
Medical careauthors
Friedman SA,Frayne SM,Berg E,Hamilton AB,Washington DL,Saechao F,Maisel NC,Lin JY,Hoggatt KJ,Phibbs CSdoi
10.1097/MLR.0000000000000296subject
Has Abstractpub_date
2015-04-01 00:00:00pages
S15-22issue
4 Suppl 1eissn
0025-7079issn
1537-1948pii
00005650-201504001-00007journal_volume
53pub_type
杂志文章相关文献
MEDICAL CARE文献大全abstract:BACKGROUND:There is an increasing demand for electronic health record (EHR)-based risk stratification and predictive modeling tools at the population level. This trend is partly due to increased value-based payment policies and the increasing availability of EHRs at the provider level. Risk stratification models, howev...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000754
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Earlier studies estimated annual income differences across specialties, but lifetime income may be more relevant given physicians' long-term commitments to specialties. METHODS:Annual income and work hours data were collected from 6381 physicians in the nationally representative 2004-2005 Community Tracking...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318268ac0c
更新日期:2012-12-01 00:00:00
abstract:BACKGROUND:Electronic health record (EHR) databases contain vast amounts of information about patients. Machine learning techniques such as Boosting and support vector machine (SVM) can potentially identify patients at high risk for serious conditions, such as heart disease, from EHR data. However, these techniques hav...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181de9e17
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Breast cancer missed on diagnostic mammography may contribute to delayed diagnoses, whereas false-positive results may lead to unnecessary invasive procedures. Whether accuracy of diagnostic mammography at facilities serving vulnerable women differs from other facilities is unknown. OBJECTIVE:To compare the...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181f380e0
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVES:Medicare hospitalizations involve both facility and physician services. Although several studies analyze hospital-level variations in Medicare inpatient facility and inpatient physician services per admission, few studies directly explore the relationship between these services. Theoretically, inpatient faci...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199702000-00002
更新日期:1997-02-01 00:00:00
abstract:OBJECTIVES:Reliability and validity are as necessary for predrafted advance directive forms as they are for all clinical assessment instruments. Performance of predrafted advance directive forms with both lay persons and clinicians is relevant. Evidence relating to test- retest reliability, content validity, and criter...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199610000-00006
更新日期:1996-10-01 00:00:00
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
更新日期:2006-10-01 00:00:00
abstract:BACKGROUND:Limited literacy has repeatedly been linked to problems comprehending health information, although the majority of studies to date have focused on reading various print health materials. We sought to investigate patients' ability to recall spoken medical instructions in the context of a hypothetical clinical...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e318241e8e1
更新日期:2012-04-01 00:00:00
abstract::Broken appointments have been a major problem at the Anthony L. Jordan Health Center since it opened in 1968. In an earlier 6-month study of broken appointments at the center the authors found 48% of pediatric appointments and 43% of medicine appointments to be broken. Daily broken appointment rates were correlated be...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198409000-00005
更新日期:1984-09-01 00:00:00
abstract:BACKGROUND:Insurance expansions and service delivery system expansions are alternative policy instruments used to try to improve birth outcomes for low-income women. OBJECTIVES:The objective of this research is to investigate the effect of expansions of public insurance on access and birth outcomes for pregnant women ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200211000-00006
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVE:We evaluated the association of medication refill adherence with demographic and prescription characteristics to determine whether such factors could guide intervention strategies in an indigent rural population. METHODS:The study was conducted at a University-based internal medicine practice serving an indi...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200212000-00016
更新日期:2002-12-01 00:00:00
abstract::This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199301000-00004
更新日期:1993-01-01 00:00:00
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
更新日期:1999-04-01 00:00:00
abstract::Each physician's ability to treat disease is limited by his/her ability to discriminate among patients on the basis of risk. The relationship of physician expectation of outcome (prognosis) to actual outcome and to cost were determined for 1,757 patients seeking primary care. Outcome was measured by a seven-level func...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-198202000-00005
更新日期:1982-02-01 00:00:00
abstract:BACKGROUND:Continuity of nursing care in hospitals remains poor and not prioritized, and we do not know whether discontinuous nursing care is negatively impacting patient outcomes. OBJECTIVES:This study aims to examine nursing care discontinuity and its effect on patient clinical condition over the course of acute hos...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000670
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVES:This paper presents a profile of the use of antipsychotic medications in the treatment of schizophrenia in a national health system. METHODS:Prescription drug records written for antipsychotic medications between June 1999 and September 1999 were collected for patients diagnosed with schizophrenia in the De...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200109000-00003
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:Measures for pay-for-performance and public reporting programs may be based on clinical practice guidelines. The impact of guideline changes over time-and whether evolving clinical evidence can render measures based on prior guidelines misleading-is not known. OBJECTIVE:To assess the impact of using differe...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e3181e35b3a
更新日期:2010-08-01 00:00:00
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
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to assess the impact of removing prior-authorization restrictions on the use of thiazolidinediones (TZDs) and outcomes. METHODS:In a controlled interrupted time-series analysis, whereby new users of antidiabetic agents over 65 years of age in adjacent Canadian provinces with differe...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000006
更新日期:2014-01-01 00:00:00
abstract:BACKGROUND:The need for evidence about the effectiveness of therapeutics and other medical practices has triggered new interest in methods for comparative effectiveness research. OBJECTIVE:Describe an approach to comparative effectiveness research involving cluster randomized trials in networks of hospitals, health pl...
journal_title:Medical care
pub_type: 杂志文章,多中心研究
doi:10.1097/MLR.0b013e3181dbebcf
更新日期:2010-06-01 00:00:00
abstract::To enhance the efficient utilization of health providers, medical care researchers are increasingly concerned with the measurement of task performance. One job analysis methodology that is widely used is the task inventory technique, characterized by retrospective self-reporting. The purpose of this study was to valid...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-197502000-00002
更新日期:1975-02-01 00:00:00
abstract::In recent years, employers, insurers, and government purchasers have paid increased attention to the measurement of patient outcomes and health status. Such interest is stimulated less by policy or quality concerns than by the need to reduce health care expenditures. Any expected benefits which might accrue from healt...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199205001-00006
更新日期:1992-05-01 00:00:00
abstract:BACKGROUND:Estimates of the costs of medical care vary across patient populations, data sources, and methods. The objective of this study was to compare 3 approaches for estimating the incidence costs of colorectal cancer (CRC) care using similar patient populations, but different data sources and methods. METHODS:We ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3181a4f482
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Increasing surgical access to previously underserved populations in the United States may require a major expansion of the use of operating rooms on weekends to take advantage of unused capacity. Although the so-called weekend effect for surgery has been described in other countries, it is unknown whether US...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000532
更新日期:2016-06-01 00:00:00
abstract:BACKGROUND:The 2006 Massachusetts health reform substantially decreased uninsurance rates. Yet, little is known about the reform's impact on actual health care utilization among poor and minority populations, particularly for receipt of inpatient surgical procedures that are commonly initiated by outpatient physician r...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e31824e319f
更新日期:2012-07-01 00:00:00
abstract:BACKGROUND:Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phen...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0000000000000729
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVES:To examine the prevalence of obesity and its relationship with pressure ulcers among nursing home (NH) populations, and whether such relationship varies with certified nursing assistant (CNA) level in NHs. DATA AND STUDY POPULATION: The 1999-2009 nationwide Minimum Data Sets were linked with Online Survey of...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/MLR.0b013e3182881cb0
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed or perceived team effectiveness and its consequences for actually making changes to improve care for people with chronic illness. STUDY SETTING AND METHODS: Data ...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-200411000-00002
更新日期:2004-11-01 00:00:00
abstract::This is a report on the extension of the concept of the appropriateness of a procedure to the necessity, or crucial importance, of that procedure. To state that a procedure is crucial means that withholding the procedure would be deleterious to the patient's health. Appropriateness and necessity ratings for six proced...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/00005650-199404000-00004
更新日期:1994-04-01 00:00:00
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 treatme...
journal_title:Medical care
pub_type: 杂志文章
doi:10.1097/01.mlr.0000215814.01127.ce
更新日期:2006-06-01 00:00:00