The quality of cost data. A caution from the Department of Veterans Affairs experience.


:Many health care system, including that of the Department of Veterans Affairs (VA), are facing dramatic changes as they adapt to state-level reform legislation and move into managed care environments. As new costing systems are designed and as researchers seek to conduct cost-effectiveness studies to guide health policy, it is critical to examine the assumed validity of the measurement procedures on which these costing systems are based. The foundation for VA health care costing is the cost distribution report, which is created by combining data on expenditures and workload with local service chiefs' estimates of program staffing and resource use. To evaluate the accuracy of the cost distribution report, the authors compared data from the report to cost data obtained in three multisite studies. Substantial differences were found between the cost distribution report and these independent sources, suggesting that researchers should not place uncritical reliance on the cost distribution report. The accuracy of costing data in information systems being implemented by VA will be limited to the extent they rely on the existing VA cost distribution system. Several strategies can be used in studies with a cost component to compensate for imperfect cost distribution systems.


Med Care


Medical care


Swindle RW Jr,Beattie MC,Barnett PG




Has Abstract


1996-03-01 00:00:00




3 Suppl








  • Patient noncompliance in the managed care setting. The case of medical therapy for glaucoma.

    abstract:OBJECTIVES:The authors identify demographic and clinical characteristics associated with noncompliance in patients beginning medical therapy for the treatment of glaucoma in a managed care setting. METHODS:The authors describe a retrospective cohort study in a group-model health maintenance organization in Massachuset...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Gurwitz JH,Yeomans SM,Glynn RJ,Lewis BE,Levin R,Avorn J

    更新日期:1998-03-01 00:00:00

  • Prior authorization policies for selective cyclooxygenase-2 inhibitors in Medicaid: a policy review.

    abstract:BACKGROUND:Many state Medicaid programs use prior authorization programs to limit spending on cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs (coxibs). However, the evidence base for the prior authorization criteria has not been examined previously. METHODS:We determined whether prior authorization was...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Fischer MA,Cheng H,Schneeweiss S,Avorn J,Solomon DH

    更新日期:2006-07-01 00:00:00

  • Nursing Home Admissions Among Medicaid HCBS Enrollees: Evidence of Racial/Ethnic Disparities or Differences?

    abstract:OBJECTIVES:Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Cai X,Temkin-Greener H

    更新日期:2015-07-01 00:00:00

  • Effects of contract adult day health care on health outcomes and satisfaction with care.

    abstract::The second phase of the ADHC Evaluation Study was designed to assess ADHC provided under contract by community ADHC programs. Outcomes for the 163 patients enrolled in this prospective cohort evaluation were compared with those of patients assigned to ADHC provided directly by VA (VA-ADHC) and customary care in the ra...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Rothman ML,Diehr P,Hedrick SC,Erdly WW,Nickinovich DG

    更新日期:1993-09-01 00:00:00

  • Predictors of aggressive therapy for nonmetastatic prostate carcinoma in Massachusetts from 1998 to 2002.

    abstract:BACKGROUND:Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE:We sought to compare the proportions of black and ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Rose AJ,Backus BM,Gershman ST,Santos P,Ash AS,Battaglia TA

    更新日期:2007-05-01 00:00:00

  • The hospital standardized mortality ratio fallacy: a narrative review.

    abstract:BACKGROUND:Outcome measures, like hospital standardized mortality ratios (HSMRs), are increasingly used to assess quality of care. The validity of HSMRs and their accuracy to reflect quality of care is heavily contested. OBJECTIVE:We explored apparent and potential shortcomings and adverse effects of the HSMR in the a...

    journal_title:Medical care

    pub_type: 杂志文章,评审


    authors: van Gestel YR,Lemmens VE,Lingsma HF,de Hingh IH,Rutten HJ,Coebergh JW

    更新日期:2012-08-01 00:00:00

  • Dimensions and correlates of physician work satisfaction in a midwestern city.

    abstract:OBJECTIVES:The purpose of this study was to examine the dimensions of physician work satisfaction across a variety of medical specialties and practice settings. METHODS:A modified version of the Scheckler et al survey instrument was mailed to all physicians in Marion County, Indiana. Forty-two percent (777) of the eli...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Bates AS,Harris LE,Tierney WM,Wolinsky FD

    更新日期:1998-04-01 00:00:00

  • After-hours telephone access to physicians with access to computerized medical records. Experience in an inner-city general medicine clinic.

    abstract::The authors examined the effect of after-hours telephone access to physicians and physician access to computerized medical records on hospitalizations and emergency room (ER) visits in an inner-city, adult, general medicine clinic. Patients were randomly assigned to a control (C) and two study groups (S1 and S2). Pati...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Darnell JC,Hiner SL,Neill PJ,Mamlin JJ,McDonald CJ,Hui SL,Tierney WM

    更新日期:1985-01-01 00:00:00

  • Health care CBA/CEA: an update on the growth and composition of the literature.

    abstract::Cost-benefit (CBA) and cost-effectiveness analyses (CEA) are methods that enumerate the costs and consequences associated with health-related technologies, services, and programs. This article examines the trends in published CBA and CEA of personal health services from 1979 through 1990. It is based on a bibliography...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Elixhauser A,Luce BR,Taylor WR,Reblando J

    更新日期:1993-07-01 00:00:00

  • The future of kidney transplantation. The effect of improvements in survival rate on the shortage of donated kidneys.

    abstract::New drugs and other medical advances in organ transplantation are expected to increase the rate of retention of transplanted kidneys, or grafts, and therefore also raise patient survival rates. In particular, the immunosuppressive drug cyclosporine has been found to reduce the likelihood of rejection of a transplanted...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Ruth RJ,Wyszewianski L,Campbell DA

    更新日期:1987-03-01 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


    authors: Yawn BP,Casey M,Hebert P

    更新日期:1999-03-01 00:00:00

  • Portal Use Among Patients With Chronic Conditions: Patient-reported Care Experiences.

    abstract:BACKGROUND:Personal health records offer patients access to view their own health information and to manage their care online through secure patient portal tools. Little is known about the patient-reported experience in using health portals to manage chronic conditions. OBJECTIVE:In a patient-centered research study, ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Reed ME,Huang J,Millman A,Graetz I,Hsu J,Brand R,Ballard DW,Grant R

    更新日期:2019-10-01 00:00:00

  • Physicians' response to length-of-stay profiling.

    abstract::One of the techniques adopted recently by certain hospitals to meet the competitive pressure for reducing costs is physician profiling. Profiling produces periodic reports that compare a physician's resource consumption to a benchmark figure. This study analyzes the effectiveness and implications of one hospital's int...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Evans JH 3rd,Hwang Y,Nagarajan N

    更新日期:1995-11-01 00:00:00

  • HMO membership and patient age and the use of specialty care for hospitalized patients with acute stroke: The Minnesota Stroke Survey.

    abstract:BACKGROUND:The number of older patients enrolling in health maintenance organizations (HMOs) is increasing. Concerns have been raised that older patients may be targeted by HMOs for more stringent cost-containment mechanisms, including reduced access to expensive specialty care. OBJECTIVES:We investigated the relation...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Smith MA,Shahar E,McGovern PG,Kane RL,Doliszny KM,Arnett DK,Luepker RV

    更新日期:1999-12-01 00:00:00

  • Complete Versus Staged Repair for Neonates With Tetralogy of Fallot: Establishment and Validation of a Cohort of 2235 Patients Using Detailed Surgery Sequence Review of Health Care Administrative Data.

    abstract:BACKGROUND:The surgical strategy for neonates with tetralogy of Fallot (TOF) consists of complete or staged repair. Assessing the comparative effectiveness of these approaches is facilitated by a large multicenter cohort. We propose a novel process for cohort assembly using the Pediatric Health Information System (PHIS...

    journal_title:Medical care

    pub_type: 杂志文章,多中心研究


    authors: Savla JJ,Fisher BT,Faerber JA,Huang YV,Mercer-Rosa L

    更新日期:2018-11-01 00:00:00

  • A comparison of contract-managed and traditionally managed nonprofit hospitals.

    abstract::During the past five years, contract management of nonprofit hospitals by for-profit corporations has increased markedly. However, while a number of studies have been conducted on investor-owned hospitals and proprietary hospital systems, contract-managed hospitals have not been evaluated systematically. This paper re...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Biggs EL,Kralewski JE,Brown GD

    更新日期:1980-06-01 00:00:00

  • Effects of Cardiovascular Health Shocks on Spouses' Work and Earnings: A National Study.

    abstract:BACKGROUND:Acute health shocks can reduce the ability to work and earn among working-age survivors. The full economic impact includes labor market effects on spouses/partners, but there is a knowledge gap in this area. OBJECTIVES:The objective of this study was to assess how 3 common health shocks, acute myocardial in...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Jeon SH,Stepner M,Rotermann M,Fransoo R,Sanmartin C,Scales DC,Wunsch H,Iwashyna TJ,Garland A

    更新日期:2020-02-01 00:00:00

  • Controlling for confounding by indication for treatment. Are administrative data equivalent to clinical data?

    abstract::There has been controversy about whether confounding by indication for treatment--that is, owing to physicians' conscious efforts to base treatment decisions on patients' pretreatment prognoses--makes nonrandomized, observational comparisons of treatments invalid. Some now believe evidence from studies of practice var...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Poses RM,Smith WR,McClish DK,Anthony M

    更新日期:1995-04-01 00:00:00

  • Ascertainment of Testosterone Prescribing Practices in the VA.

    abstract:BACKGROUND:Prescribing of exogenous testosterone is increasing. Because of the risks associated with testosterone, it is important to follow evidence-based procedures when initiating therapy. OBJECTIVE:We evaluated whether dispensing of testosterone was preceded by appropriate ascertainment of androgen deficiency, and...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Jasuja GK,Bhasin S,Reisman JI,Berlowitz DR,Rose AJ

    更新日期:2015-09-01 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


    authors: Perneger TV,Chamot E,Bovier PA

    更新日期:2005-04-01 00:00:00

  • Inference With Difference-in-Differences With a Small Number of Groups: A Review, Simulation Study, and Empirical Application Using SHARE Data.

    abstract:BACKGROUND:Difference-in-differences (DID) estimation has become increasingly popular as an approach to evaluate the effect of a group-level policy on individual-level outcomes. Several statistical methodologies have been proposed to correct for the within-group correlation of model errors resulting from the clustering...

    journal_title:Medical care

    pub_type: 杂志文章,评审


    authors: Rokicki S,Cohen J,Fink G,Salomon JA,Landrum MB

    更新日期:2018-01-01 00:00:00

  • Predictors of older adults' longitudinal dental care use. Ten-year results.

    abstract::Our purpose was to identify factors predictive of reported dental care use by elders (65+) over a ten-year period in Massachusetts. The Massachusetts Health Care Panel Study began in 1974-75 (wave 1) as a statewide survey of 1625 noninstitutionalized elders. Wave 2 occurred in 1976, wave 3 in 1980, and wave 4 in 1985....

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Gilbert GH,Branch LG,Orav EJ

    更新日期:1990-12-01 00:00:00

  • Price and membership in a prepaid group medical practice.

    abstract::Federal interest in prepaid group practices as a means to control rising health care costs in reviving. This article is an empirical study of price and membership at a prepaid group practice among employees of Yale University. This article is the first to estimate the effect of price on the decision for membership in ...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: McGuire TG

    更新日期:1981-02-01 00:00:00

  • Paid work and unpaid help by caregivers of the disabled and frail elders.

    abstract::Informal caregiving by women, and to a lesser extent by men, is a major source of assistance for the chronically disabled and most dependent older persons living in the community. However, because women's commitment to career employment may diminish, this source of help at the time when (according to demographic trend...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Boaz RF,Muller CF

    更新日期:1992-02-01 00:00:00

  • Psychological distress and the decision to seek medical care among a Medicare population.

    abstract::Although there have been a number of studies linking psychological distress to the demand for medical care, few studies have examined this relationship among the aged. The issue is important, however, partly because it has been suggested that distress might cause some individuals to seek unneeded medical care. The fin...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Berkanovic E,Hurwicz ML

    更新日期:1989-11-01 00:00:00

  • Changes in follow-up care for Medicare surgical patients under the prospective payment system.

    abstract::In this study, changes in the number, site, and source of follow-up visits and allowed charges were examined for follow-up visits provided to Medicare surgical patients between 1984 and 1986. Among the 21 surgical procedures studied, follow-up visits decreased by 5.2%, after adjusting for case mix. Despite the physici...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Kominski GF,Biddle AK

    更新日期:1993-03-01 00:00:00

  • Provider response to computer-based care suggestions for chronic heart failure.

    abstract:OBJECTIVES:We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). METHODS:This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a ...

    journal_title:Medical care

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Keeffe B,Subramanian U,Tierney WM,Udris E,Willems J,McDonell M,Fihn SD

    更新日期:2005-05-01 00:00:00

  • A cross-lagged model of psychiatric problems and health-related quality of life among a national sample of HIV-positive adults.

    abstract:OBJECTIVES:To investigate the temporal association between symptoms of psychiatric disorder and physical aspects of health-related quality of life (HRQOL) in a sample of HIV-positive adults. METHODS:Sample included 2431 participants at baseline and the first follow-up (FU1; approximately 8 months later). Measures incl...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Orlando M,Tucker JS,Sherbourne CD,Burnam MA

    更新日期:2005-01-01 00:00:00

  • Continuity of medical care: its impact on physician utilization.

    abstract::Past research in continuity of medical care has generally examined its determinants or its consequences. A model is proposed which combines these lines of research and incorporates a continuity measure as a process and specifying variable. The validity of this model is tested with a set of data consisting of 1,410 per...

    journal_title:Medical care

    pub_type: 杂志文章


    authors: Hennelly VD,Boxerman SB

    更新日期:1979-10-01 00:00:00

  • Measuring the necessity of medical procedures.

    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


    authors: Kahan JP,Bernstein SJ,Leape LL,Hilborne LH,Park RE,Parker L,Kamberg CJ,Brook RH

    更新日期:1994-04-01 00:00:00