Screening for Sexually Transmitted Infections After Cervical Cancer Screening Guideline and Medicaid Policy Changes: A Population-based Analysis.

Background: Sexually transmitted infection (STI) screening prevents complications and is cost-effective. Annual screening is recommended in sexually active women below 25 years and older women at increased risk. Cervical cancer (CC) screening guideline changes in 2009 and 2012 recommended less frequent screening, causing concern that STI screening would decrease.

Cervical Cancer Screening Guideline Adherence Before and After Guideline Changes in Pennsylvania Medicaid.

Objective: To assess changes in cervical cancer screening after the 2009 American College of Obstetricians and Gynecologists' guideline change and to determine predictors associated with underscreening and overscreening among Medicaid-enrolled women.

Methods: We performed an observational cohort study of Pennsylvania Medicaid claims from 2007 to 2013. We evaluated guideline adherence of 18- to 64-year-old continuously enrolled women before and after the 2009 guideline change.

Regional Variation in Physician Adoption of Antipsychotics: Impact on US Medicare Expenditures.

Background: Regional variation in US Medicare prescription drug spending is driven by higher prescribing of costly brand-name drugs in some regions. This variation likely arises from differences in the speed of diffusion of newly-approved medications. Second-generation antipsychotics were widely adopted for treatment of severe mental illness and for several off-label uses.

Satisfaction of Discharged Nursing Home Residents.

The psychometric properties of The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Nursing Home survey: Discharged Resident Instrument (NHCAHPS-D) are examined. A random sample of 550 nursing homes was selected from across the United States and 365 agreed to participate (participation rate = 66%). From 7,020 surveys sent to discharged residents, 4,926 were returned (response rate = 70%).

Antipsychotic prescribing: do conflict of interest policies make a difference?

Background: Academic medical centers (AMCs) have increasingly adopted conflict of interest policies governing physician-industry relationships; it is unclear how policies impact prescribing.

Objectives: To determine whether 9 American Association of Medical Colleges (AAMC)-recommended policies influence psychiatrists' antipsychotic prescribing and compare prescribing between academic and nonacademic psychiatrists.

Research Design: We measured number of prescriptions for 10 heavily promoted and 9 newly introduced/reformulated antipsychotics between 2008 and 2011 among 2464 academic psychiatrists at 101 AMCs and 11,201 nonacademic psychiatrists.

Twelve-month cost-effectiveness of telephone-delivered collaborative care for treating depression following CABG surgery: a randomized controlled trial.

Objective: To determine the 12-month cost-effectiveness of a collaborative care (CC) program for treating depression following coronary artery bypass graft (CABG) surgery versus physicians' usual care (UC).

Methods: We obtained 12 continuous months of Medicare and private medical insurance claims data on 189 patients who screened positive for depression following CABG surgery, met criteria for depression when reassessed by telephone 2 weeks following hospitalization (nine-item Patient Health Questionnaire ≥10) and were randomized to either an 8-month centralized, nurse-provided and telephone-delivered CC intervention for depression or to their physicians' UC.

Results: At 12 months following randomization, CC patients had $2068 lower but statistically similar estimated median costs compared to UC (P=.

Impact of medicare part D plan features on use of generic drugs.

Background: Little is known about how Medicare Part D plan features influence choice of generic versus brand drugs.

Objectives: To examine the association between Part D plan features and generic medication use.

Methods: Data from a 2009 random sample of 1.

The impact of Medicare prescription drug coverage on the use of antidementia drugs.

Background: Cholinesterase inhibitors and memantine are prescribed to slow the progression dementia. Although the efficacy of these drugs has been demonstrated, their effectiveness, from the perspective of patients and caregivers, has been questioned. Little is known about whether the demand for cholinesterase inhibitors and memantine are sensitive to out-of-pocket cost.

Medicare Part D and potentially inappropriate medication use in the elderly.

Objectives: Inappropriate medication use, which is common in older adults, may be responsive to out-of-pocket costs. We examined the impact of Medicare Part D on inappropriate medication use among Medicare beneficiaries.

Study Design: Pre-post with comparison group.

Impact of Medicare Part D on antidepressant treatment, medication choice, and adherence among older adults with depression.

Objectives: Depression in older adults is often undertreated due, in part, to medication costs. We examined the impact of improved prescription drug coverage under Medicare Part D on use of antidepressants, medication choice, and adherence.

Design, Setting And Participants: Observational claims-based study of older adults with depression (ICD-9: 296.

Nursing home deficiency citations for infection control.

Background: This study examined the deficiency citation for infection control (ie, F-Tag 441). This information represents potential problems in infection control as identified in the yearly certification process of almost all US nursing homes.

Methods: The data used came primarily from the Online Survey, Certification, and Reporting data base, which contains information on both deficiency citations and characteristics of nursing homes.

Employee choice of a high-deductible health plan across multiple employers.

Objective: To determine factors associated with selecting a high-deductible health plan (HDHP) rather than a preferred provider plan (PPO) and to examine switching and market segmentation after initial selection.

Data Sources/study Setting: Claims and benefit information for 2005-2007 from nine employers in western Pennsylvania first offering HDHP in 2006.

Study Design: We examined plan growth over time, used logistic regression to determine factors associated with choosing an HDHP, and examined the distribution of healthy and sick members across plan types.

The Medicare drug benefit (Part D) and treatment of heart failure in older adults.

Background: Adherence to pharmacotherapy for heart failure is poor among older adults in part because of high prescription drug costs. We examined the impact of improvements in drug coverage under Medicare Part D on utilization of, and adherence to, medications for heart failure in older adults.

Methods: We used a quasi-experimental approach to analyze pharmacy claims for 6,950 individuals aged >or=65 years with heart failure enrolled in a Medicare managed care organization 2 years before and after Part D's implementation.

Certified nursing assistants' perceptions of nursing home patient safety culture: is there a relationship to clinical outcomes?

Objectives: The main objective of this study was to examine whether certified nursing assistants' (CNAs') perceptions of patient safety culture (PSC) were correlated with clinical outcomes (rates of falls, pressure ulcers, and daily restraint use) in a random sample of nursing homes. An additional objective was to describe facility-level and CNA-level characteristics that were associated with CNA PSC scores.

Design: We conducted a secondary data analysis using data that adapted the Hospital Survey of Patient Safety Culture (HSOPSC) for nursing homes.

Variation in the use of nursing home deficiency citations.

Several sources of variation are associated with the number of survey deficiencies that can be received by nursing homes in the yearly survey and certification process. One source is variation across states. A second source of variation occurs within states.

Nurse aide agency staffing and quality of care in nursing homes.

Data from a large sample of nursing homes are used to examine the association between use of nurse aide agency staff and quality. Agency use data come from a survey conducted in 2005 (N = 2,840), and the quality indicators come from the Nursing Home Compare Web site. The authors found a nonlinear relationship between nurse aide agency levels and quality; however, in general, higher nurse aide agency levels were associated with low quality.

Nursing home staff turnover: impact on nursing home compare quality measures.

Purpose: We used data from a large sample of nursing homes to examine the association between staff turnover and quality.

Design And Methods: The staff turnover measures came from primary data collected from 2,840 nursing homes in 2004 (representing a 71% response rate). Data collection included measures for nurse aides, licensed practical nurses, and registered nurses.

Job satisfaction of nurse aides in nursing homes: intent to leave and turnover.

Purpose: The relationship between job satisfaction of nurse aides and intent to leave and actual turnover after 1 year is examined.

Design And Methods: Data came from a random sample of 72 nursing homes from 5 states (Colorado, Florida, Michigan, New York, and Oregon). From these nursing homes, we collected 1,779 surveys from nurse aides (a response rate of 62%).

Downsizing in the nursing home industry.

Downsizing in the nursing home industry from 1992 to 2003 was examined. Most significantly, we show that downsizing is subsequently associated with improved quality.