Medical home effects on enrollees with mental and physical illness.

Objectives: To assess the effect of medical home enrollment on acute care use and healthcare spending among Medicaid beneficiaries with mental and physical illness.

Study Design: Retrospective cohort analysis of administrative data.

Methods: We used 2007-2010 Medicaid claims and state psychiatric hospital data from a sample of 83,819 individuals diagnosed with schizophrenia or depression and at least 1 comorbid physical condition.

Quality, Costs, and Policy: Factors Influencing Choice of Anesthesia Staffing Models.

Certified registered nurse anesthetists (CRNAs) can practice independently or with varying degrees of supervision by physicians or anesthesiologists. Before 2001, the Centers for Medicare & Medicaid Services (CMS) conditions of participation required CRNAs to be supervised by a physician. Starting in November 2001, CMS implemented an opt-out policy to give states greater autonomy in determining how anesthesia services are delivered.

Multi-Payer Advanced Primary Care Practice Demonstration on quality of care.

Objectives: We evaluated whether primary care practices in the Medicare Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration improved the quality of care and patient outcomes for beneficiaries.

Study Design: For our quantitative analyses, we employed a pre-post study design with a comparison group using enrollment data, Medicare fee-for-service claims data, and Medicaid managed care and fee-for-service claims data, covering the period 2 to 4 years before Medicare joined the state patient-centered medical home initiatives through December 2014. We used difference-in-differences (DID) regression analysis to compare quality and outcomes in the period before and after the demonstration began.

Maryland's Global Hospital Budgets: Impacts on Medicare Cost and Utilization for the First 3 Years.

Background: Global budgets have been proposed as a way to control health care expenditures, but experience with them in the United States is limited. Global budgets for Maryland hospitals, the All-Payer Model, began in January 2014.

Objectives: To evaluate the effect of hospital global budgets on health care utilization and expenditures.

Comparison group selection in the presence of rolling entry for health services research: Rolling entry matching.

Objective: To demonstrate rolling entry matching (REM), a new statistical method, for comparison group selection in the context of staggered nonuniform participant entry in nonrandomized interventions.

Study Setting: Four Health Care Innovation Award (HCIA) interventions between 2012 and 2016.

Study Design: Center for Medicare and Medicaid Innovation HCIA participants entering these interventions over time were matched with nonparticipants who exhibited a similar pattern of health care use and expenditures during each participant's baseline period.

Do Medical Homes Improve Quality of Care for Persons with Multiple Chronic Conditions?

Objective: To examine the association between medical home enrollment and receipt of recommended care for Medicaid beneficiaries with multiple chronic conditions (MCC).

Data Sources/study Setting: Secondary claims data from fiscal years 2008-2010. The sample included nonelderly Medicaid beneficiaries with at least two of eight target conditions (asthma, chronic obstructive pulmonary disease, diabetes, hypertension, hyperlipidemia, seizure disorder, major depressive disorder, and schizophrenia).

Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia.

Objective: Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home.

Method: We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007-2010.

Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?

Objective: Primary-care-based medical homes may facilitate care transitions for persons with multiple chronic conditions (MCC) including serious mental illness. The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity.

Methods: Using a quasi-experimental design, we examined data from North Carolina Medicaid-enrolled adults with MCC hospitalized with an inpatient diagnosis of depression or schizophrenia during 2008-2010.

Opportunities to Create New General Surgery Residency Programs to Alleviate the Shortage of General Surgeons.

Purpose: To estimate the capacity for supporting new general surgery residency programs among U.S. hospitals that currently do not have such programs.

Effectiveness of Intermittent Pneumatic Compression Devices for Venous Thromboembolism Prophylaxis in High-Risk Surgical Patients: A Systematic Review.

Background: Thromboprophylaxis regimens include pharmacologic and mechanical options such as intermittent pneumatic compression devices (IPCDs). There are a wide variety of IPCDs available, but it is uncertain if they vary in effectiveness or ease of use. This is a systematic review of the comparative effectiveness of IPCDs for selected outcomes (mortality, venous thromboembolism [VTE], symptomatic or asymptomatic deep vein thrombosis, major bleeding, ease of use, and adherence) in postoperative surgical patients.

Association between Initial Fluid Choice and Subsequent In-hospital Mortality during the Resuscitation of Adults with Septic Shock.

Background: Currently, guidelines recommend initial resuscitation with intravenous (IV) crystalloids during severe sepsis/septic shock. Albumin is suggested as an alternative. However, fluid mixtures are often used in practice, and it is unclear whether the specific mixture of IV fluids used impacts outcomes.

Effects of provision of type 2 diabetes genetic risk feedback on patient perceptions of diabetes control and diet and physical activity self-efficacy.

Objective: We examined effects of providing type 2 diabetes genetic risk feedback on controllability perceptions.

Methods: This is a secondary analysis of a randomized controlled trial in which overweight/obese Veterans Affairs patients without diabetes received conventional type 2 diabetes risk counseling that included either (1) personalized diabetes genetic risk feedback (genetic risk arm) or (2) eye disease counseling (comparison arm). Perceived diabetes control, and dietary and physical activity self-efficacy were compared between study arms, and between the comparison arm and each of 3 DNA-based genetic risk levels.

First outpatient follow-up after psychiatric hospitalization: does one size fit all?

Objective: Claims-based indicators of follow-up within seven and 30 days after psychiatric discharge have face validity as quality measures: early follow-up may improve disease management and guide appropriate service use. Yet these indicators are rarely examined empirically. This study assessed their association with subsequent health care utilization for adults with comorbid conditions.

Extent and reasons for nonadherence to antihypertensive, cholesterol, and diabetes medications: the association with depressive symptom burden in a sample of American veterans.

Objective: Persons with depressive symptoms generally have higher rates of medication nonadherence than persons without depressive symptoms. However, little is known about whether this association differs by comorbid medical condition or whether reasons for nonadherence differ by depressive symptoms or comorbid medical condition.

Methods: Self-reported extent of nonadherence, reasons for nonadherence, and depressive symptoms among 1,026 veterans prescribed medications for hypertension, dyslipidemia, and/or type 2 diabetes were assessed.

Trends in emergent hernia repair in the United States.

Importance: Abdominal wall hernia is one of the most common conditions encountered by general surgeons. Rising rates of abdominal wall hernia repair have been described; however, population-based evidence concerning incidence rates of emergent hernia repair and changes with time are unknown.

Objective: To examine trends in rates of emergent abdominal hernia repair within the United States for inguinal, femoral, ventral, and umbilical hernias from January 1, 2001, to December 31, 2010.

Do medical homes increase medication adherence for persons with multiple chronic conditions?

Background: Medications are an integral component of management for many chronic conditions, and suboptimal adherence limits medication effectiveness among persons with multiple chronic conditions (MCC). Medical homes may provide a mechanism for increasing adherence among persons with MCC, thereby enhancing management of chronic conditions.

Objective: To examine the association between medical home enrollment and adherence to newly initiated medications among Medicaid enrollees with MCC.

Racial and ethnic disparities in discharge to rehabilitation following traumatic brain injury.

Object: Disparities in access to inpatient rehabilitation services after traumatic brain injury (TBI) have been identified, but less well described is the likelihood of discharge to a higher level of rehabilitation for Hispanic or black patients compared with non-Hispanic white patients. The authors investigate racial disparities in discharge destination (inpatient rehabilitation vs skilled nursing facility vs home health vs home) following TBI by using a nationwide database and methods to address racial differences in prehospital characteristics.

Methods: Analysis of discharge destination for adults with moderate to severe TBI was performed using National Trauma Data Bank data for the years 2007-2010.

State Investments in Psychiatric Innovation: Investigating Unmeasured State Factors.

We apply three separate panel data estimation methods to examine the diffusion of technologies at the state-level. These methods include the Hausman-Taylor random effects model, the fixed effects vector decomposition (FEVD), and generalized estimating equations (GEE). We discuss the assumptions required of each and assess the stability of our policy results across the three models for a longitudinal study of the diffusion of newer psychotropic technologies.

Strategic planning to reduce the burden of stroke among veterans: using simulation modeling to inform decision making.

Background And Purpose: Reducing the burden of stroke is a priority for the Veterans Affairs Health System, reflected by the creation of the Veterans Affairs Stroke Quality Enhancement Research Initiative. To inform the initiative's strategic planning, we estimated the relative population-level impact and efficiency of distinct approaches to improving stroke care in the US Veteran population to inform policy and practice.

Methods: A System Dynamics stroke model of the Veteran population was constructed to evaluate the relative impact of 15 intervention scenarios including both broad and targeted primary and secondary prevention and acute care/rehabilitation on cumulative (20 years) outcomes including quality-adjusted life years (QALYs) gained, strokes prevented, stroke fatalities prevented, and the number-needed-to-treat per QALY gained.

Use of medical homes by patients with comorbid physical and severe mental illness.

Background: Patients with comorbid severe mental illness (SMI) may use primary care medical homes differently than other patients with multiple chronic conditions (MCC).

Objective: To compare medical home use among patients with comorbid SMI to use among those with only chronic physical comorbidities.

Research Design: We examined data on children and adults with MCC for fiscal years 2008-2010, using generalized estimating equations to assess associations between SMI (major depressive disorder or psychosis) and medical home use.

Heterogeneity in the quality of care for patients with multiple chronic conditions by psychiatric comorbidity.

Background: Little is known about the quality of care received by Medicaid enrollees with multiple chronic conditions (MCCs) and whether quality is different for those with mental illness.

Objectives: To examine cancer screening and single-disease quality of care measures in a Medicaid population with MCC and to compare quality measures among persons with MCC with varying medical comorbidities with and without depression or schizophrenia.

Research Design: Secondary data analysis using a unique data source combining Medicaid claims with other administrative datasets from North Carolina's mental health system.