Abstract:
BACKGROUND:Developing a definition of what constitutes high need among Medicare beneficiaries using administrative data is an important prerequisite to evaluating value-based payment reforms. While various definitions of high need exist, their predictive validity for different patient outcomes in the following year has not been systematically assessed for both fee-for-service (FFS) and Medicare Advantage (MA) beneficiaries. OBJECTIVE:To develop a definition of high need using administrative data in 2014 and to examine its predictive validity for patient outcomes in 2015 as compared to alternative definitions for both FFS and MA beneficiaries. DESIGN:Retrospective cohort study of national Medicare claims and post-acute assessment data. PARTICIPANTS:All Medicare beneficiaries in 2014 who survived until the end of the year (n = 54,717,039). MAIN MEASURES:Two or more complex conditions, 6 or more chronic conditions, acute or post-acute health services utilization, indicators of frailty, complete dependency in mobility or in any activities of daily living in post-acute care assessments, hospitalization, mortality, days in community, Medicare expenditures. KEY RESULTS:Based on our definition of high-need patients, 13.17% of FFS and 8.85% of MA beneficiaries were identified as high need in 2014. High-need FFS patients had mortality rates 7.1 times higher (16.23% vs. 2.27%) and hospitalization rates 3.4 times higher (40.69 vs. 12.03) in 2015 compared to other beneficiaries. Competing high-need definitions all had good specificity (≥ 0.88). Having 3 or more Hierarchical Chronic Conditions yielded a good positive predictive value for hospitalization, at 0.50, but only identified 19.71% of FFS beneficiaries hospitalized and 28.46% of FFS decedents that year as high need, as opposed to 33.92% and 51.98% for the new definition. Results were similar for MA beneficiaries. CONCLUSIONS:The proposed high-need definition has better sensitivity and yields a sample of almost 5 million FFS and 1.5 million MA beneficiaries, facilitating outcome performance comparisons across health systems.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Bélanger E,Silver B,Meyers DJ,Rahman M,Kumar A,Kosar C,Mor Vdoi
10.1007/s11606-018-4781-3subject
Has Abstractpub_date
2019-03-01 00:00:00pages
405-411issue
3eissn
0884-8734issn
1525-1497pii
10.1007/s11606-018-4781-3journal_volume
34pub_type
杂志文章abstract:BACKGROUND:Health-related quality of life (HRQoL) has become an important facet of HIV/AIDS research. Typically, the unit of analysis is either the total instrument score or subscale score. Developing a typology of responses across various HRQoL measures, however, may advance understating of patients' perspectives. ME...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2006.00645.x
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:High-quality communication about end-of-life care results in greater patient and family satisfaction. End-of-life discussions should occur early during the patient's disease trajectory and yet is often addressed only when patients become severely ill. As a result, end-of-life discussions are commonly initiat...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05615-1
更新日期:2020-04-01 00:00:00
abstract:BACKGROUND:Previous studies indicate that medical trainees frequently experience discrimination by patients. Little is known about effective strategies to teach trainees to respond to this discrimination. AIM:To create a workshop for first-year residents utilizing standardized patients to improve skills in responding ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-04881-3
更新日期:2019-05-01 00:00:00
abstract:BACKGROUND:Multiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care. OBJECTIVE:To describe regional variation in outpatient visits for individual specialties and the association between spec...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-016-3745-8
更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:The relationship between worklife factors, clinician outcomes, and time pressure during office visits is unclear. OBJECTIVE:To quantify associations between time pressure, workplace characteristics ,and clinician outcomes. DESIGN:Prospective analysis of data from the Healthy Work Place randomized trial. P...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05343-6
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:Residency programs involve trainees in quality improvement (QI) projects to evaluate competency in systems-based practice and practice-based learning and improvement. Valid approaches to assess QI proposals are lacking. OBJECTIVE:We developed an instrument for assessing resident QI proposals--the Quality Im...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0260-y
更新日期:2007-09-01 00:00:00
abstract::Older adults often have multiple chronic conditions that may decrease additional life expectancy. Research evaluating the benefits and harms of screening must include consideration of competing morbidities and patient heterogeneity (beyond age), potentially increased harms of screening, and patient preferences. Other ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,评审
doi:10.1007/s11606-012-2227-x
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:In our ever-increasingly multicultural, multilingual society, medical interpreters serve an important role in the provision of care. Though it is known that using untrained interpreters leads to decreased quality of care for limited English proficiency patients, because of a short supply of professionals and...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2502-5
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:Heart failure (HF) is a leading cause of hospitalization. Clinical and socio-demographic factors have been associated with cardiac admissions, but little is known about the role of anxiety. We examined whether symptoms of anxiety were associated with cardiac hospitalizations at 12 months in HF patients. METH...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-011-1843-1
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:To measure and compare patient satisfaction with care in resident and attending physician internal medicine ambulatory care clinics. DESIGN:A cross-sectional survey using a questionnaire derived from the Visit-Specific Satisfaction Questionnaire (VSQ) and Patient Satisfaction Index (PSI) distributed from Mar...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2001.91005.x
更新日期:2001-11-01 00:00:00
abstract:BACKGROUND:While victims of intimate partner violence (IPV) present to health care settings for a variety of complaints; rates and predictors of case identification and intervention are unknown. OBJECTIVE:Examine emergency department (ED) case finding and response within a known population of abused women. DESIGN:Ret...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1662-4
更新日期:2011-08-01 00:00:00
abstract::Despite improved knowledge about the benefits and harms of treatments for chronic back pain in the past several decades, there is a large and consequential mismatch between treatments found safe and effective and those routinely covered by health insurance. As a result, care for back pain has, if anything, deteriorate...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05099-z
更新日期:2019-09-01 00:00:00
abstract:BACKGROUND:The three-item Brief Health Literacy Screen (BHLS) has been validated in research settings, but not in routine practice, administered by clinical personnel. OBJECTIVE:As part of the Health Literacy Screening (HEALS) study, we evaluated psychometric properties of the BHLS to validate its administration by cl...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2568-0
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVE:To describe how medical residents discuss do-not-resuscitate (DNR) orders with patients. DESIGN:Prospective observational study. SETTING:Inpatient medical wards of one university tertiary care center, one urban city public hospital, and one Veterans Affairs medical center. PARTICIPANTS:Thirty-one medical r...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599915
更新日期:1995-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of an intensive intervention to implement guidelines for cost-effective management of hypertension on medication use and cost, blood pressure control, and other resource use. DESIGN:Retrospective cohort trial based on the Cleveland Veterans' Affairs Medical Center Firm System. SETTIN...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600265
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Rapid antigen detection tests (RADT) are commonly used to guide appropriate antibiotic treatment of group A beta-hemolytic streptococcal (GABHS) pharyngitis. In adults, there is controversy about the need for routine backup testing of negative RADT. OBJECTIVE:Estimate the costs and benefits in adults of rou...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-012-2245-8
更新日期:2013-06-01 00:00:00
abstract:MAIN RESULTS:Compared with younger patients, patients aged 50 years or older were less likely to have acquired HIV via intravenous drug use or homosexual contact (p = .0001). Older patients were more likely to have comorbid diseases (12% vs 4%; p = .0001), had more frequent neurologic findings on admission (19% vs 9%; ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02599026
更新日期:1996-10-01 00:00:00
abstract::The community of health services researchers in general internal medicine has played an important role in affecting health policy at the national and state levels. Community-based participatory research (CBPR) offers health services researchers an opportunity to identify and address health policy questions at the loca...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-011-1878-3
更新日期:2011-12-01 00:00:00
abstract:OBJECTIVE:1) To determine whether the frequencies of panic disorder (PD) and depression (DEP) in an emergency department (ED) population were comparable to those in other primary care groups; 2) to evaluate whether patients without the clinical diagnosis of acute cardiac ischemia (ACI) had higher frequencies of these d...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02600087
更新日期:1993-05-01 00:00:00
abstract:INTRODUCTION:Whether the clinical vignettes presented at the Society of General Internal Medicine (SGIM) annual meeting could be of educational value to third year students in the Internal Medicine clerkship has not been studied. OBJECTIVE:To explore the relevance and learning value of clinical vignettes from the SGIM...
journal_title:Journal of general internal medicine
pub_type:
doi:10.1111/j.1525-1497.2006.00596.x
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Racial and ethnic minority groups have lower levels of leisure-time physical activity (LTPA) than whites, but it is unclear how much of this is explained by differences in socioeconomic status and health. OBJECTIVE:To examine differences in LTPA, work-related physical activity (WRPA; heavy household chores ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1111/j.1525-1497.2005.40198.x
更新日期:2005-03-01 00:00:00
abstract::To investigate the value of home urine glucose testing in assessing chronic diabetic glucose control, the authors compared patients' glycosuria patterns with their mean blood glucose (MBG) levels calculated from glycosylated hemoglobin (Hb Alc). One hundred and twenty-one patients who regularly checked their urines re...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596192
更新日期:1986-07-01 00:00:00
abstract:BACKGROUND:Leaders play a crucial role in implementing and sustaining changes in clinical practice, yet there is limited evidence on the strategies to engage them in team problem solving and communication. OBJECTIVE:Examine the impact of an intervention focused on facilitating leadership during daily huddles on optimi...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-020-06487-6
更新日期:2021-01-26 00:00:00
abstract:BACKGROUND:As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings. OBJECTIVE:We measured adoption of medical home features by VHA primary care clinics prior to wides...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s11606-013-2405-5
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:Direct-to-consumer advertising (DTCA) remains a controversial issue, with concerns that it leads to unnecessary and inappropriate prescribing. Whether DTCA shifts prescribing from first-line (guideline-recommended) therapy to second-line drugs has not been studied. OBJECTIVE:The purpose of this study was to...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-014-3063-y
更新日期:2015-04-01 00:00:00
abstract:OBJECTIVE:The Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) seeks to develop partnerships between VA health services researchers and clinical managers, with the goal of designing and evaluating interventions to improve the quality of VA health care. METHODS:In the present report we describe one...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-009-1155-x
更新日期:2010-01-01 00:00:00
abstract::To investigate the frequency of physician delivery of advice to stop smoking and patient characteristics affecting whether physicians deliver such advice, the authors surveyed 97 current cigarette smokers seen in two specialty and one general medicine clinic at a university medical center. Approximately two thirds of ...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/BF02596170
更新日期:1987-09-01 00:00:00
abstract:BACKGROUND:The double-blind placebo-controlled design is commonly considered the gold standard in research methodology; however, subject expectation bias could subvert blinding. OBJECTIVE:The primary aim of this study was to examine the impact of expectation bias. Specifically, we examined perceived treatment assignme...
journal_title:Journal of general internal medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11606-008-0656-3
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:Approximately 20% of patients with atherosclerotic cardiovascular disease (ASCVD) suffer from depression. OBJECTIVE:To compare healthcare expenditures and utilization, healthcare-related quality of life, and patient-centered outcomes among ASCVD patients, based on their risk for depression (among those with...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-019-05325-8
更新日期:2019-11-01 00:00:00
abstract:BACKGROUND:The placebo and the placebo effect are often investigated in the context of clinical trials. Little data exist on the use of placebos in the course of routine health care. OBJECTIVE:The aim of this study is to describe a group of academic physicians' use of placebos and their knowledge, attitudes, and belie...
journal_title:Journal of general internal medicine
pub_type: 杂志文章
doi:10.1007/s11606-007-0332-z
更新日期:2008-01-01 00:00:00