Using 15-Minute Serial Blood Pressures as an Alternative to Measuring a Single Blood Pressure.

Thirty-minute office blood pressure (OBP-30) is an alternative to ambulatory blood pressure (BP) measurement, yet is impractical to implement. This study aimed to determine whether unattended BP readings over 15 minutes would result in a similar probability of obtaining a BP of <140/90. Sixty-seven adults self-described as having high BP were analyzed.

Gaps In Quality Of Care Not Consistent Between Traditional Medicare, Medicare Advantage For Racial And Ethnic Groups.

The quality of care experienced by members of racial and ethnic minority groups in Medicare Advantage, which is an increasingly important source of Medicare coverage for these groups, has critical implications for health equity. Comparing gaps in Medicare Advantage and traditional Medicare for three quality-of-care outcomes, measured by adverse health events, between minority and non-Hispanic White populations, we found that the relative magnitude of the gaps varied both by racial and ethnic minority group and by quality measure. Hispanic versus non-Hispanic White gaps were smaller in Medicare Advantage than in traditional Medicare for all outcomes: avoidable emergency department use, preventable hospitalizations, and thirty-day hospital readmissions.

The mechanics of risk adjustment and incentives for coding intensity in Medicare.

Objective: To study diagnosis coding intensity across Medicare programs, and to examine the impacts of changes in the risk model adopted by the Centers for Medicare and Medicaid Services (CMS) for 2024.

Data Sources And Study Setting: Claims and encounter data from the CMS data warehouse for Traditional Medicare (TM) beneficiaries and Medicare Advantage (MA) enrollees.

Study Design: We created cohorts of MA enrollees, TM beneficiaries attributed to Accountable Care Organizations (ACOs), and TM non-ACO beneficiaries.

Successful Change Management Strategies for Improving Diabetes Care Delivery Among High-Performing Practices.

Purpose: To learn how the highest-performing primary care practices manage change when implementing improvements to diabetes care delivery.

Methods: We ranked a total of 330 primary care practices submitting practice management assessments and diabetes reports to the Understanding Infrastructure Transformation Effects on Diabetes study in 2017 and 2019 by Optimal Diabetes Care performance. We ranked practices from the top quartile by greatest annual improvement to capture dynamic change.

Evaluating the Clinical Effect of Personal Continuous Glucose Monitoring in a Diverse Population With Type 2 Diabetes.

To determine the clinical effect of personal continuous glucose monitoring (CGM) in a diverse population with type 2 diabetes (T2D). A report was created from the electronic health record identifying adults prescribed CGM at an urban family medicine clinic between January 1, 2019, and February 23, 2022. An "index date" was identified as the start of CGM.

Wide Variation In Differences In Resource Use Seen Across Conditions Between Medicare Advantage, Traditional Medicare.

Medicare Advantage (MA) is a rapidly growing source of coverage for Medicare beneficiaries. Examining how MA performs compared with traditional Medicare is an important policy issue. We analyzed national MA encounter data and found that the adjusted differences in resource use between MA and traditional Medicare varied widely across medical conditions in 2019.

Care Management Processes Important for High-Quality Diabetes Care.

Objective: Identify the improvement in diabetes performance measures and population-based clinical outcomes resulting from changes in care management processes (CMP) in primary care practices over 3 years.

Research Design And Methods: This repeated cross-sectional study tracked clinical performance measures for all diabetes patients seen in a cohort of 330 primary care practices in 2017 and 2019. Unit of analysis was patient-year with practice-level CMP exposures.

Osteopathic manipulative treatment for the allopathic resident elective: does it change practice after graduation?

Context: Osteopathic manipulative treatment (OMT) for the allopathic resident is an elective at the University of Minnesota North Memorial Residency that engages the resident in the basic tenants of osteopathic medicine, with exposure to the vast application of OMT with a curricular focus on low back pain management. Implementing an elective curriculum is a feasible way to improve attitudes in OMT for MDs in a Family Medicine residency, and residents can learn OMT in an elective rotation.

Objectives: This article aims to determine if MDs who complete an OMT for the allopathic physician elective rotation have higher comfort caring for patients with back pain compared to those who do not complete the elective.

COVID-19 Impacts on Primary Care Clinic Care Management Processes.

Purpose: To learn whether the COVID-19 pandemic's disruptions and associated reduced health outcomes for people with chronic conditions might have been caused by a decrease in care management processes (CMPs) in primary care clinics METHODS: Longitudinal cohort design with repeated survey-based measures of CMPs from 2017, 2019, and 2021 in 269 primary care clinics in Minnesota.

Results: There were only small differences in organizational characteristics and no differences in overall CMPs between the 269 clinics analyzed and the 287 that only completed surveys in 1 or 2 years. Overall CMP scores rose by similar amounts (1.

Diabetes care quality: do large medical groups perform better?

Objectives: To compare primary care management processes (CMPs) and outcome measures for diabetes quality among large, medium, and small medical groups.

Study Design: Observational comparison of differences in processes and outcomes over time among 329 primary care practices that agreed to participate and returned completed surveys in both 2017 and 2019.

Methods: We used a standardized composite measure of diabetes quality along with its 5 components and a survey measure of the presence of systematic CMPs to compare the outcomes and processes of care among clinics that were in large (≥ 12 sites), medium (4-11 sites), and small (1-3 sites) medical groups.

Bayesian variable selection in hierarchical difference-in-differences models.

A popular method for estimating a causal treatment effect with observational data is the difference-in-differences model. In this work, we consider an extension of the classical difference-in-differences setting to the hierarchical context in which data cannot be matched at the most granular level. Our motivating example is an application to assess the impact of primary care redesign policy on diabetes outcomes in Minnesota, in which the policy is administered at the clinic level and individual outcomes are not matched from pre- to post-intervention.

Evaluation of 30-Minute Office Blood Pressure in a Diverse Urban Population.

Background: Previous studies have shown benefits of 30-minute office blood pressure (OBP-30) but did not report on race and gender. The purpose of this study was to determine if similar effects are seen in a diverse urban population.

Methods: Patients with diabetes and/or cardiovascular disease (age 18-89) were invited to participate.

Strategies and Factors Associated With Top Performance in Primary Care for Diabetes: Insights From a Mixed Methods Study.

Purpose: The aim of this study was to determine what strategies and factors are most important for high performance in the primary care of patients with diabetes.

Methods: We performed a mixed-methods, cross-sectional, observational analysis of interviews and characteristics of primary care clinics in Minnesota and bordering areas. We compared strategies, facilitators, and barriers identified by 31 leaders of 17 clinics in high-, middle-, and low-performance quartiles on a standardized composite measure of diabetes outcomes for 416 of 586 primary care clinics.

The Effect of Depression and Rurality on Diabetes Control.

Background: Having depression and living in a rural environment have separately been associated with poor diabetes outcomes, but there little is known about the interaction between the 2 risk factors. This study investigates the association of depression and rurality with glycemic control in adults, as well as their interaction.

Methods: This is a repeated cross-sectional study with data collected from 2010 to 2017 (n = 1,697,173 patient-year observations), comprising a near-complete census of patients with diabetes in Minnesota.

The impact of patient-centered medical home certification on quality of care for patients with diabetes.

Objective: To identify the impact of changes surrounding certification as a patient-centered medical home (PCMH) on outcomes for patients with diabetes.

Study Setting: Minnesota legislation established mandatory quality reporting for patients with diabetes and statewide standards for certification as a PCMH. Patient-level quality reporting data (2008-2018) were used to study the impact of transition to a PCMH.

Narrow provider networks and willingness to pay for continuity of care and network breadth.

Tiered and narrow provider networks are mechanisms implemented by health plans to reduce health care costs. The benefits of narrow networks for consumers usually come in the form of lower premiums in exchange for access to fewer providers. Narrow networks may disrupt continuity of care and access to usual sources of care.

Evidence of Pent-Up Demand for Care After Medicaid Expansion.

We compared new Medicaid enrollees with similar ongoing enrollees for evidence of pent-up demand using claims data following Minnesota's 2014 Medicaid expansion. We hypothesized that if new enrollees had pent-up demand, utilization would decline over time as testing and disease management plans are put in place. Consistent with pent-up demand among new enrollees, the probability of an office visit, a new patient office visit, and an emergency department visit declines over time for new enrollees relative to ongoing Medicaid enrollees.

The impact of provider consolidation on physician prices.

When a clinic system is acquired by an integrated delivery system (IDS), the ownership change includes both vertical integration with the hospital(s), and horizontal integration with the IDS's previously owned or "legacy" clinics, causing increased market concentration in physician services. Although there is a robust literature on the impact of hospital market concentration, the literature on physician market concentration is sparse. The objective of this study is to determine the impact on physician prices when two IDSs acquired three multispecialty clinic systems in Minneapolis-St Paul, Minnesota at the end of 2007, using commercial claims data from a large health plan (2006-2011).

Improving Patient-Centered Care by Assessing Patient Preferences for Multiple Sclerosis Disease-Modifying Agents: A Stated-Choice Experiment.

Context: Long-term adherence to pharmaceutical treatment for multiple sclerosis (MS) is poor. A focus on patient preferences when determining the patient's therapeutic plan may improve this experience.

Objective: To identify factors important to patients with MS when evaluating their options for pharmaceutical agents that deliver disease-modifying therapy.

Adherence to Disease-Modifying Therapies for Multiple Sclerosis.

Background: Multiple sclerosis (MS) is a neurological degenerative chronic condition without cure. However, long-term disease-modifying therapies (DMTs) help reduce the severity of MS symptoms. Adherence to DMTs is key to their success.

Affordable Care Act's Mandate Eliminating Contraceptive Cost Sharing Influenced Choices Of Women With Employer Coverage.

Patient cost sharing for contraceptive prescriptions was eliminated for certain insurance plans as part of the Affordable Care Act. We examined the impact of this change on women's patterns of choosing prescription contraceptive methods. Using claims data for a sample of midwestern women ages 18-46 with employer-sponsored coverage, we examined the contraceptive choices made by women in employer groups whose coverage complied with the mandate, compared to the choices of women in groups whose coverage did not comply.

System Transformation in Patient-Centered Medical Home (PCMH): Variable Impact on Chronically Ill Patients' Utilization.

Background: Research connecting patient-centered medical homes (PCMHs) with improved quality and reduced utilization is inconsistent, possibly because individual domains of change, and the stage of change, are not incorporated in the research design. The objective of this study was to examine the association between stage and domain of change and patterns of health care utilization.

Methods: This was a cross-sectional observational study that including 87 Minnesota clinics certified as medical homes.

The Impact of Hospital Acquisition of Physician Practices on Referral Patterns.

Multiple parties influence the choice of facility for hospital-based inpatient and outpatient services. The patient is the central figure, but their choice of facility is guided by their physician and influenced by hospital characteristics. This study estimated changes in referral patterns for inpatient admissions and outpatient diagnostic imaging associated with changes in ownership of three multispecialty clinic systems headquartered in Minneapolis-St.

Changes in Quality of Health Care Delivery after Vertical Integration.

Objectives: To fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area.

Data Sources/study Setting: Administrative data for health plan enrollees attributed to treatment and control clinic systems, merged with U.S.