Association Between Physician Risk Assessment, Hierarchical Condition Categories, and Utilization of Medical Services.

Hierarchical Condition Categories (HCCs) are a common risk adjustment tool that may support alignment of care management resources with the clinical needs of a population. The authors examined the association between HCC scores and physician-determined clinical risk (CR) scores, annual charges, and utilization of medical care. CR score was defined as the anticipated risk for "ED or a hospital admission" within the following year.

Transitions between SNF and home-based care in patients with multiple sclerosis.

Objectives: To assess patient characteristics and risk factors associated with care transitions between skilled nursing facility (SNF) and home care for patients with multiple sclerosis (MS) in an effort to improve outcomes and optimize patient care pathways.

Background: MS is a chronic neurologic illness of younger adults that is associated with physical disability, cognitive impairment and a high need for supportive services.

Methods: The study was based on the 2005 Nursing Home Minimum Data Set and the Outcome and Assessment Information Set data (n = 10,064).

Is There Extra Cost of Institutional Care for MS Patients?

Throughout life, patients with multiple sclerosis (MS) require increasing levels of support, rehabilitative services, and eventual skilled nursing facility (SNF) care. There are concerns that access to SNF care for MS patients is limited because of perceived higher costs of their care. This study compares costs of caring for an MS patient versus those of a typical SNF patient.

Cost-effectiveness of the School-Based Asthma Therapy (SBAT) program.

Background And Objective: Impoverished urban children suffer disproportionately from asthma and underuse preventive asthma medications. The objective of this study was to examine cost-effectiveness (CE) of the School-Based Asthma Therapy (SBAT) program compared with usual care (UC).

Methods: The analysis was based on the SBAT trial, including 525 children aged 3 to 10 years attending urban preschool or elementary school who were randomized to either UC or administration of 1 dose of preventive asthma medication at school by the school nurse each school day.

Variations in service use in the Program of All-Inclusive Care for the Elderly (PACE): is more better?

Background: To date, there has been little empirical evidence about the relationship between service use and risk-adjusted functional outcomes among the frail, chronically ill elderly population. The Program of All-Inclusive Care for the Elderly (PACE) offers a unique model within which to investigate this relationship. We examine variation in the risk-adjusted utilization of acute, rehabilitative, and supportive services in PACE, and assess whether use of these services is associated with risk-adjusted functional outcomes.

Impact of the State Children's Health Insurance Program on adolescents in New York.

Objectives: Adolescents face financial and nonfinancial barriers to health care. Little is known about the impact of health insurance on health care for adolescents. We assessed the impact of New York's State Children's Health Insurance Program on access, use, and quality of care for adolescents.

Improved health care among children with special health care needs after enrollment into the State Children's Health Insurance Program.

Objective: To assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with special health care needs (CSHCN).

Methods: Little is known about the impact of health insurance on CSHCN. Parents of a stratified random sample of new enrollees onto New York's SCHIP were interviewed by telephone at enrollment (n = 2644) and 1 year later (n = 2290, 87% response).

Improved asthma care after enrollment in the State Children's Health Insurance Program in New York.

Background: Uninsured children with asthma are known to face barriers to asthma care, but little is known about the impact of health insurance on asthma care.

Objectives: We sought to assess the impact of New York's State Children's Health Insurance Program (SCHIP) on health care for children with asthma.

Design: Parents of a stratified random sample of new enrollees in New York's SCHIP were interviewed by telephone shortly after enrollment (baseline, n = 2644 [74% of eligible children]) and 1 year later (follow-up, n = 2310 [87%]).

Disenrollment from an acute/long-term managed care program (PACE).

Background: The Program of All-Inclusive Care for the Elderly (PACE) is an acute/long-term managed care plan designed to care for the most frail and vulnerable Medicare beneficiaries. To our knowledge, this is a first study to examine patterns and predictors of disenrollment from PACE.

Objective: PACE, with its comprehensive delivery system, dual capitation, and a focus on the most vulnerable population, may be expected to achieve low rates of exit and little selective dissenrollment.

Nursing home spending patterns in the 1990s: the role of nursing home competition and excess demand.

Objective: To examine nursing home expenditures on clinical, hotel, and administrative activities during the 1990s and to determine the association between nursing home competition and excess demand on expenditures.

Data Sources/study Setting: Secondary data sources for 1991, 1996, and 1999 for 500 free-standing nursing homes in New York State.

Study Design: A retrospective statistical analysis of nursing homes' expenditures.

Social support and risk-adjusted mortality in a frail older population.

Objective: The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services.

Research Design And Methods: The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the Elderly (PACE). Information about the enrollees is obtained from dataPACE.

Variations in risk-adjusted outcomes in a managed acute/long-term care program for frail elderly individuals.

Objective: To develop and investigate the properties of three performance measures based on risk-adjusted health outcomes for a frail, elderly, community-dwelling population enrolled in a managed, acute, and long-term care program.

Design: Retrospective analyses of an administrative dataset containing individual level records with information about socioeconomics, health, functional and cognitive status, diagnoses, and treatments. We estimated risk-adjustment models predicting mortality, decline in functional status, and decline in self-assessed health.

Health care services utilization at the end of life in a managed care program integrating acute and long-term care.

Background: The period preceding death is often characterized by increased utilization of medical resources. There is an ongoing debate on the reasons for and the appropriateness of increased utilization at the end of life.

Objectives: To study end-of-life practices in the PACE program and to assess the contribution of individual characteristics versus program site to the variation in use of services.