Mortality Changes Associated with Mandated Public Reporting for Sepsis. The Results of the New York State Initiative.

Rationale: In 2013, the New York State Department of Health (NYSDOH) began a mandatory state-wide initiative to improve early recognition and treatment of severe sepsis and septic shock.

Objectives: This study examines protocol initiation, 3-hour and 6-hour sepsis bundle completion, and risk-adjusted hospital mortality among adult patients with severe sepsis and septic shock.

Methods: Cohort analysis included all patients from all 185 hospitals in New York State reported to the NYSDOH from April 1, 2014, to June 30, 2016.

Reporting of Sepsis Cases for Performance Measurement Versus for Reimbursement in New York State.

Objectives: Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database.

Design: Observational cohort study.

Improving Adjuvant Hormone Therapy Use in Medicaid Managed Care-Insured Women, New York State, 2012-2014.

Introduction: In 2010, national guidelines recommended that women with nonmetastatic, hormone receptor-positive breast cancer take adjuvant hormone therapy for 5 years. As results from randomized clinical trials became available, guidelines were revised in 2014 to recommend 10 years of therapy. Despite evidence of its efficacy, low initiation rates have been documented among women insured by New York State Medicaid.

Variation in breast cancer care quality in New York and California based on race/ethnicity and Medicaid enrollment.

Background: Racial/ethnic and socioeconomic disparities persist in part because our current understanding of the care provided to minority and disadvantaged populations is limited. The authors evaluated the quality of breast cancer care in 2 large states to understand the disparities experienced by African Americans, Hispanics, Asian/Pacific Islanders (APIs), and Medicaid enrollees and to prioritize remediation strategies.

Methods: Statewide cancer registry data for 80,436 women in New York and 121,233 women in California who were diagnosed during 2004 to 2009 with stage 0 through III breast cancer were used to assess underuse and overuse of surgery, radiation, chemotherapy, and hormone therapy based on 34 quality measures.

High Intensity of End-of-Life Care Among Adolescent and Young Adult Cancer Patients in the New York State Medicaid Program.

Background: Little is known about the care that adolescent and young adult (AYA) cancer patients receive at the end of life (EOL).

Objective: To evaluate use of intensive measures and hospice and location of death of AYA cancer patients insured by Medicaid in New York State.

Design: Using linked patient-level data from the New York State Cancer Registry and state Medicaid program, we identified 705 Medicaid patients who were diagnosed with cancer between the ages of 15 and 29 in the years 2004-2011, who subsequently died, and who were continuously enrolled in Medicaid in the last 60 days of life.

Transforming the Primary Care Training Clinic: New York State's Hospital Medical Home Demonstration Pilot.

Background: Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs.

Objective: Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided.

Predicting potentially preventable hospital readmissions following bariatric surgery.

Background: Using hospital readmissions as a quality of care measure predicates that some readmissions were preventable.

Objectives: This study identifies predictors of potentially preventable readmissions (PPR) within 30 days of bariatric surgery discharge.

Setting: New York State acute care hospitals.

Underuse of hospice care by Medicaid-insured patients with stage IV lung cancer in New York and California.

Purpose: Medicare patients with advanced cancer have low rates of hospice use. We sought to evaluate hospice use among patients in Medicaid, which insures younger and indigent patients, relative to those in Medicare.

Patients And Methods: Using linked patient-level data from California (CA) and New York (NY) state cancer registries, state Medicaid programs, NY Medicare, and CA Surveillance, Epidemiology, and End Results-Medicare data, we identified 4,797 CA Medicaid patients and 4,001 NY Medicaid patients ages 21 to 64 years, as well as 27,416 CA Medicare patients and 16,496 NY Medicare patients ages ≥ 65 years who were diagnosed with stage IV lung cancer between 2002 and 2006.

Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved.

In September 2011 the Centers for Medicare and Medicaid Services awarded $85 million in grants to ten states to test financial incentive programs to encourage healthy behavior among Medicaid enrollees with chronic diseases. There is little published evidence about the effectiveness of such incentives within the Medicaid program. We evaluated the available research from three earlier Medicaid incentive programs and found mixed results.

Initiation of adjuvant hormone therapy by Medicaid insured women with nonmetastatic breast cancer.

Hormone therapy is the mainstay of adjuvant treatment for hormone receptor positive (HR-positive) nonmetastatic breast cancer. We evaluated adjuvant hormone therapy (AHT) initiation among Medicaid-insured women aged 21-64 years with stage I-III HR-positive breast cancer. We used multivariable logistic regression to identify independent predictors of AHT initiation.

Emergency department reliance among rural children in Medicaid in New York State.

Purpose: This study examines variation in emergency department reliance (EDR) between rural and metro pediatric Medicaid patients in New York State for noninjury, nonpoisoning primary diagnoses and seeks to determine the relationship between receipt of preventive care and the likelihood of EDR.

Methods: Rural/urban designations were based on Urban Influence Codes established by the United States Department of Agriculture (USDA). Healthcare Effectiveness Data and Information Set (HEDIS(®)) well-visit measures were calculated using 2008 Medicaid claims and encounter data.

Cancer disparities in the context of Medicaid insurance: a comparison of survival for acute myeloid leukemia and Hodgkin's lymphoma by Medicaid enrollment.

Background: Because poverty is difficult to measure, its association with outcomes for serious illnesses such as hematologic cancers remains largely uncharacterized. Using Medicaid enrollment as a proxy for poverty, we aimed to assess potential disparities in survival after a diagnosis of acute myeloid leukemia (AML) or Hodgkin's lymphoma (HL) in a nonelderly population.

Methods: We used records from the New York (NY) and California (CA) state cancer registries linked to Medicaid enrollment records for these states to identify Medicaid enrolled and nonenrolled patients aged 21-64 years with incident diagnoses of AML or HL in 2002-2006.

Can prenatal care impact future well-child visits? The experience of a low income population in New York State Medicaid managed care.

To examine the association between maternal characteristics and care patterns and the subsequent utilization of well-child visits in a low income population in New York State (NYS). We analyzed Medicaid managed care birth data from 2004 to 2005 linked to an administrative database to obtain information on preventive well-care visits for the child. The outcome variable was whether the child had five or more well-child visits (WCVs) in their first 15 months of life.

Bariatric surgery for obesity: surgical approach and variation in in-hospital complications in New York State.

Background: The purpose of this study was to demonstrate the relationship between the surgical approach employed for adults undergoing bariatric surgery for obesity in New York State and in-hospital postoperative complications. Understanding the differences among surgical approaches in terms of the type, extent, and likelihood of postoperative complications and the patient characteristics associated with them, particularly as the annual volume of bariatric surgery increases, can inform decisions about the appropriate bariatric surgical approach for patients with particular characteristics.

Methods: Using New York's inpatient hospital discharge database, we identified 8,413 adults who underwent a bariatric surgical procedure during calendar year 2006.

Asthma in Medicaid managed care enrollees residing in New York City: results from a post-World Trade Center disaster survey.

The collapse of the World Trade Center on September 11, 2001, released a substantial amount of respiratory irritants into the air. To assess the asthma status of Medicaid managed care enrollees who may have been exposed, the New York State Department of Health, Office of Managed Care, conducted a mail survey among enrollees residing in New York City. All enrollees, aged 5-56 with persistent asthma before September 11, 2001, were surveyed during summer 2002.

Quality oversight and improvement in Medicaid managed care.

New York State has been collecting performance data from managed care plans that serve the Medicaid population since 1993. The data come to the state via the Quality Assurance Reporting Requirements--a series of quality of care, access, and utilization measures, largely based on the Health Plan Employer Data and Information Set, as well as several New York State-specific measures. In addition to collecting the data, the state publishes the information, works with plans that have below average rates of performance and provides a number of program and financial rewards to plans for rates that demonstrate high quality care.

Do commercial managed care members rate their health plans differently than Medicaid managed care members?

Objective: To determine if members of commercial managed care and Medicaid managed care rate the experience with their health plans differently.

Data Sources: Data from both commercial and Medicaid Consumer Assessment of Health Plan Surveys (CAHPS) in New York State.

Study Design: Regression models were used to determine the effect of population (commercial or Medicaid) on a member's rating of their health plan, controlling for health status, age, gender, education, race/ethnicity, number of office visits, and place of residence.