Adoption of Health System Innovations: Evidence of Urban-Rural Disparities from the Ohio Primary Care Marketplace.

Background: Accountable care organizations (ACOs), patient-centered medical homes (PCMHs), and the meaningful use of electronic health records (EHRs) generated particular attention during the last decade. Translating these reforms into meaningful increases in population health depends on improving the quality and clinical integration of primary care providers (PCPs). However, if these innovations spread more quickly among PCPs in urban and wealthier areas, then they could potentially worsen existing geographic disparities in health outcomes.

Optimal Omeprazole Dosing and Symptom Control: A Randomized Controlled Trial (OSCAR Trial).

Background: Proton pump inhibitors (PPIs) are potent inhibitors of acid secretion and are the mainstay of therapy for gastroesophageal reflux disease (GERD). Initially designed to be taken 30 min before the first daily meal, these agents are commonly used suboptimally, which adversely affects symptom relief. No study to date has assessed whether correcting dosing regimens would improve symptom control.

Association Of A Regional Health Improvement Collaborative With Ambulatory Care-Sensitive Hospitalizations.

Although regional health improvement collaboratives have been adopted nationwide to improve primary care quality, their effects on avoidable hospitalizations and costs remain unclear. We quantified the association of the Better Health Partnership, a primary care-led regional health improvement collaborative operating in Cuyahoga County, Ohio (Cleveland and surrounding suburbs), with hospitalization rates for ambulatory care-sensitive conditions. The partnership uses a positive deviance approach to identify, disseminate publicly, and accelerate adoption of best practices for care of patients with diabetes, heart failure, and hypertension.

Divorced fathers' proximity and children's long-run outcomes: evidence from Norwegian registry data.

This study examines the link between divorced nonresident fathers' proximity and children's long-run outcomes, using high-quality data from Norwegian population registers. We follow (from birth to young adulthood) each of 15,992 children born into married households in Norway in the years 1975-1979 whose parents divorced during his or her childhood. We observe the proximity of the child to his or her father in each year following the divorce and link proximity to educational and economic outcomes for the child in young adulthood, controlling for a wide range of observable characteristics of the parents and the child.

Effects of neighborhood characteristics on the mortality of black male youth: evidence from Gautreaux, Chicago.

We estimate the effect of neighborhood characteristics on the mortality of poor black male youth in families relocated through the Gautreaux Assisted Housing Program, a residential mobility program implemented in Chicago, USA in 1976. Within our sample (N=2850), 52 post-placement deaths were observed, the majority of which (30) were homicides. All-cause and homicide mortality rates were substantially lower among those relocating to Census tracts with higher fractions of residents with college degrees, which suggests that relocating to more-advantaged neighborhoods can ameliorate the mortality risks faced by this population.

Medical cost savings associated with 17 alpha-hydroxyprogesterone caproate.

Objective: This study was undertaken to assess the impact of 17 alpha hydroxyprogesterone caproate treatment on future medical costs for expectant mothers with a prior spontaneous preterm birth.

Study Design: Data on the costs of preterm birth were combined with published data on the effectiveness of 17 alpha hydroxyprogesterone caproate to produce estimates of the effect of treatment on expected future direct medical costs. These estimates were compared with an estimate of the cost of a typical 17 alpha hydroxyprogesterone caproate treatment regimen to estimate the net savings per treated woman.

Redirecting patients to improve stroke outcomes: implications of a volume-based approach in one urban market.

Background: The designation of primary stroke centers may result in patients being redirected from their usual source of care, although there is little evidence that these centers would result in better outcomes or lower costs. An alternative approach could direct patients to hospitals treating greater volumes of stroke patients.

Objectives: We sought to estimate the effect of hospital stroke volume on patient mortality and costs in a regional hospital market and to analyze the implications of hypothetical volume-based referral policies in that market, including the effects of patient-hospital distance.

Overcoming bias in estimating the volume-outcome relationship.

Objective: To examine the effect of hospital volume on 30-day mortality for patients with congestive heart failure (CHF) using administrative and clinical data in conventional regression and instrumental variables (IV) estimation models.

Data Sources: The primary data consisted of longitudinal information on comorbid conditions, vital signs, clinical status, and laboratory test results for 21,555 Medicare-insured patients aged 65 years and older hospitalized for CHF in northeast Ohio in 1991-1997.

Study Design: The patient was the primary unit of analysis.