Abstract:
OBJECTIVE:We evaluate the impact of membership in a staff-model health maintenance organization (HMO) on hospital admission rates for patients presenting to an emergency department with acute chest pain. DATA SOURCES AND STUDY SETTING:Primary prospective data were gathered from all 3,006 patients presenting with a chief complaint of chest pain to the emergency department (ED) of a university teaching hospital from October 1987 to November 1989. STUDY DESIGN:Prospective cohort analysis used clinical data to stratify patients into groups at high (> or = 25%), medium (8-24%), and low risk (< or = 7%) of acute myocardial infarction (AMI). Insurance status was determined as either HMO, Medicare, commercial, Medicaid, or self-pay. Triage decisions were recorded, and patient outcomes of AMI and other final diagnoses were determined for all patients. DATA COLLECTION METHODS:Clinical data were recorded by the physicians in the ED as part of a detailed protocol. Insurance data were recorded separately by the ED staff as part of the hospital administrative database. Patient outcomes were recorded daily by research nurses for hospitalized patients; for patients who were discharged from the ED, telephone or physician follow-up was accomplished within seven days after discharge. PRINCIPAL FINDINGS:HMO patients were more likely to be admitted to the hospital than patients in other insurance groups in both the medium- and low-risk patient categories. Within the low-risk category, after controlling for clinical differences in a multiple logistic model, HMO membership retained an independent positive association with hospital admission compared to all other insurance groups except Medicaid. CONCLUSIONS:For patients with acute chest pain who were at medium and low risk of acute myocardial infarction, HMO membership was associated with higher rates of hospital admission. These findings suggest that organizational factors beyond financial incentives may exercise an important influence on hospitalization rates for HMO patients.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Pearson SD,Lee TH,Lindsey E,Hawkins T,Cook EF,Goldman Lsubject
Has Abstractpub_date
1994-04-01 00:00:00pages
59-74issue
1eissn
0017-9124issn
1475-6773journal_volume
29pub_type
杂志文章abstract:OBJECTIVES:To examine variation in risk-adjusted reinsurance payments across Part D plans, analyze its implications for the program, and explore options to reduce reinsurance payments. DATA/STUDY DESIGN:2007-2015 Part D Plan Payment and Premium data; 2010-2013 Part D Prescription Drug Event data; and 2013 Part D Plan ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12866
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:Our research compares health care use by Medicaid beneficiaries with that of the uninsured and the privately insured to measure the program's effect on access to care. DATA SOURCES/STUDY SETTING:Data include the 1987 National Medical Expenditure Survey and the Survey of Income and Program Participation for 1...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1996-02-01 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 factors affecting willingness to pay (WTP) for health insurance of older adults in a longitudinal setting in Germany. DATA SOURCES:Survey data from a cohort study in Saarland, Germany, from 2008-2010 and 2011-2014 (n1 = 3,124; n2 = 2,761) were used. STUDY DESIGN:Panel data were taken at two...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12522
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVE:To estimate the total hours of paid and unpaid personal assistance of daily living provided to adults living at home in the United States using nationally representative household survey data. DATA SOURCES:The Disability Followback Survey of the National Health Interview Survey on Disability (NHIS-D) conduct...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.029
更新日期:2002-04-01 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 determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. DATA SOURCES/STUDY SETTING:The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. STUDY DESIGN:We conducted a retrosp...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12529
更新日期:2017-06-01 00:00:00
abstract::The concept of propensity to use ambulatory care is defined as the probability that a utilization occurs in a very small interval of time, given that no utilization has been observed before. With this definition of utilization, survival analysis can be used to assess the effect of a set of predictors on utilization. T...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1988-06-01 00:00:00
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 co...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2005.00461.x
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVE:To compare utilization and preventive care receipt among patients of federal Section 330 health centers (HCs) versus patients of other settings. DATA SOURCES:A nationally representative sample of adults from the Medical Expenditure Panel Survey (2004-2008). STUDY DESIGN:HC patients were defined as those wit...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12178
更新日期:2014-10-01 00:00:00
abstract:OBJECTIVE:To assess the extent and consistency of geographic differences in the use of post-acute care (PAC), and the stability of this pattern of variation. DATA SOURCES:The 5 percent Medicare data sample for 1996, 1997, and the first eight months of 1998 were used. STUDY DESIGN:Patterns of PAC use for various Diagn...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.00043
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:To explain variation in direct care resource use (RU) of nursing home residents based on the Resource Utilization Groups III (RUG-III) classification system and other resident- and unit-level explanatory variables. DATA SOURCES/STUDY SETTING:Primary data were collected on 5,314 nursing home residents in 156 ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00627.x
更新日期:2007-04-01 00:00:00
abstract::The axioms of utility theory are restated in terms of health outcomes, and some additional assumptions, consistent with the assumptions implicit in health status index models, are adduced to develop a consistent theory of the utility of health states. On the basis of the axioms and specific assumptions, techniques for...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1976-01-01 00:00:00
abstract:OBJECTIVE:To determine whether Medicaid home care spending reduces the proportion of the disabled elderly population who do not get help with personal care. DATA SOURCES:Data on Medicaid home care spending per poor elderly person in each state is merged with data from the Medicare Current Beneficiary Survey for 1992, ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2007.00762.x
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:Apply quantile regression for a high-resolution analysis of changes in wait time to treatment and assess its applicability to quality improvement data compared with least-squares regression. DATA SOURCE:Addiction treatment programs participating in the Network for the Improvement of Addiction Treatment. MET...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01436.x
更新日期:2013-02-01 00:00:00
abstract:OBJECTIVE:To examine the implications of serious and chronic health problems on the willingness of enrollees to switch health plans if they are dissatisfied with their current arrangements. DATA SOURCE:A large (20,283 respondents) survey of employees of three national corporations committed to the model of managed com...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVES:Eight grant teams used Agency for Healthcare Research and Quality infrastructure development research grants to enhance the clinical content of and improve race/ethnicity identifiers in statewide all-payer hospital administrative databases. PRINCIPAL FINDINGS:Grantees faced common challenges, including recr...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12330
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:We investigate the factors driving the downward trend in employer sponsored health insurance (ESI) coverage between 1999 and 2002 for low- and middle-income workers, and assess their insurance options in the absence of ESI coverage. DATA:We use the 1999 and 2002 rounds of the National Survey of America's Fam...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00590.x
更新日期:2006-12-01 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::Organizations are increasingly becoming dynamic and unstable. This evolution has given rise to greater reliance on teams and increased complexity in terms of team composition, skills required, and degree of risk involved. High-reliability organizations (HROs) are those that exist in such hazardous environments where t...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2006.00566.x
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND:During welfare reform, Congress passed legislation barring legal immigrants who entered the United States after August 1996 from Medicaid for five years after immigration. This legislation intended to bar only new immigrants (post-1996 immigrants) from Medicaid. However it may have also deterred the enrollme...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2004.00301.x
更新日期:2004-10-01 00:00:00
abstract:OBJECTIVE:To extend recent conceptual and methodological advances in disparities research to include the incorporation of genomic information in analyses of racial/ethnic disparities in health care and health outcomes. DATA SOURCES:Published literature on human genetic variation, the role of genetics in disease and re...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/j.1475-6773.2012.01413.x
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:The use of Medicaid data to study cancer-related outcomes would be highly desirable. However, the accuracy of Medicaid claims data in the identification of incident cases of breast cancer is unknown. OBJECTIVES:(1) To estimate the sensitivity of Medicaid claims data for case ascertainment of breast cancer, ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.00155
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:To develop a framework that public health practitioners could use to measure the value of public health services. DATA SOURCES:Primary data were collected from August 2006 through March 2007. We interviewed (n=46) public health practitioners in four states, leaders of national public health organizations, an...
journal_title:Health services research
pub_type: 杂志文章,多中心研究
doi:10.1111/j.1475-6773.2009.01013.x
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:To review two indirect methods, geocoding and surname analysis, for estimating race/ethnicity as a means for health plans to assess disparities in care. STUDY DESIGN:Review of published articles and unpublished data on the use of geocoding and surname analyses. PRINCIPAL FINDINGS:Few published studies have ...
journal_title:Health services research
pub_type: 杂志文章,评审
doi:10.1111/j.1475-6773.2006.00551.x
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:To examine implementation of the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs, enacted in 1988. The article summarizes the origin of the QMB and SLMB programs, describes what we have learned about QMB and SLMB enrollment in state Medicaid programs and, des...
journal_title:Health services research
pub_type: 杂志文章
doi:
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:To examine the influence of place of graduate medical education (GME), state licensure requirements, presence of established international medical graduates (IMGs), and ethnic communities on the initial practice location choices of new IMGs. DATA SOURCES:The annual Graduate Medical Education (GME) Survey of ...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1034/j.1600-0560.2002.58.x
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVE:To demonstrate how a researcher can investigate the appropriateness of a published comorbidity summary measure for use with a given sample. DATA SOURCE:Surveillance, Epidemiology, and End Results linked to Medicare claims data. STUDY DESIGN:We examined Kaplan-Meier estimated survival curves for four disease...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12276
更新日期:2015-08-01 00:00:00
abstract:OBJECTIVE:Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on qual...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12035
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVES:To explore effects of disease prevalence adjustment on ambulatory care-sensitive hospitalization (ACSH) rates used for quality comparisons. DATA SOURCES/STUDY SETTING:County-level hospital administrative data on adults discharged from German hospitals in 2011 and prevalence estimates based on administrative...
journal_title:Health services research
pub_type: 杂志文章
doi:10.1111/1475-6773.12680
更新日期:2018-04-01 00:00:00