Does the Race/Ethnicity or Gender of a Physician's Name Impact Patient Selection of the Physician?

This study's objective was to examine the extent to which individuals exhibit a preference for physicians based upon the race/ethnicity and gender of a physician's name. We conducted an online survey of 915 adults, who viewed a comparative display of four physicians' quality performance. We randomized the name of one physician, whose quality performance was equal to that of one physician and better than two other physicians, to be either typically African American male, African American female, white male, white female, or Middle Eastern (gender ambiguous).

Prenatal Development and Adolescent Obesity: Two Distinct Pathways to Diabetes in Adulthood.

Objective: Higher body-mass index (BMI) and lower birth weight (BW) are associated with elevated risk of diabetes in adulthood, but the extent to which they compose two distinct pathways is unclear.

Methods: We used data from the National Longitudinal Study of Adolescent to Adult Health, a cohort of adolescents (1994-1995) followed for 14 years over four waves into adulthood (n = 13,413). Sex-stratified path analysis was used to examine pathways from BW [kg; linear (BW) and quadratic (BW)] to latent trajectories in BMI from adolescence to adulthood to prevalent diabetes or prediabetes (pre/diabetes) in adulthood, adjusting for sociodemographic characteristics.

Presenting Cost and Efficiency Measures That Support Consumers to Make High-Value Health Care Choices.

Objective: To identify approaches to presenting cost and resource use measures that support consumers in selecting high-value hospitals.

Data Sources: Survey data were collected from U.S.

High birth weight modifies association between adolescent physical activity and cardiometabolic health in women and not men.

Recent evidence suggests that adverse prenatal development alters physiological response to physical activity, but longitudinal epidemiologic evidence is scant. This study tested the hypothesis that lower physical activity during adolescence and young adulthood is more strongly associated with later cardiovascular disease (CVD) risk and diabetes or prediabetes (DM/PDM) in women and men who were born with high or low birth weight (HBW, LBW), compared to normal birth weight (NBW). We analyzed data from the National Longitudinal Study of Adolescent to Adult Health, a cohort study of US adolescents followed into adulthood (1994-2009).

Childhood Maltreatment and BMI Trajectory: The Mediating Role of Depression.

Introduction: Childhood maltreatment is associated with later obesity, but the underlying mechanisms are unknown. The objective of this study was to estimate the extent to which depression mediates the associations between childhood maltreatment and BMI in adolescence through adulthood.

Methods: Data on a cohort of 13,362 adolescents in the National Longitudinal Study of Adolescent to Adult Health (Wave I [1994-1995] to Wave IV [2008-2009]) were analyzed in 2015-2016.

Testing a Personal Narrative for Persuading People to Value and Use Comparative Physician Quality of Care Information: An Experimental Study.

This study tests whether a personal narrative can persuade people to value comparative data on physician quality. We conducted an online experiment with 850 adults. One group viewed a cartoon narrative on physician quality variation, another saw text on physician quality variation, and there was a control group.

Does patient activation predict the course of type 2 diabetes? A longitudinal study.

Objective: To examine whether patient activation is predictive of the course of diabetes over a three year period among patients with and without diabetes.

Methods: Longitudinal analyses utilized electronic health record data from 2011 to 2014. We examined how the patient activation measure (PAM) was predictive of 2014 diabetes-related outcomes among patients with diabetes (n=10,071); pre-diabetes (n=1804); and neither diabetes nor pre-diabetes (n=46,402).

How much do clinicians support patient self-management? The development of a measure to assess clinician self-management support.

Background: Primary care provider (PCP) support of patient self-management may be important mechanism to improving patient health outcomes. In this paper we develop a PCP-reported measure of clinician strategies for supporting patient self-management, and we psychometrically test and validate the measure.

Methods: We developed survey items based upon effective self-management support strategies identified in a prior mixed methods study.

Improving Population Health Management Strategies: Identifying Patients Who Are More Likely to Be Users of Avoidable Costly Care and Those More Likely to Develop a New Chronic Disease.

Objective: To explore using the Patient Activation Measure (PAM) for identifying patients more likely to have ambulatory care-sensitive (ACS) utilization and future increases in chronic disease.

Data Sources: Secondary data are extracted from the electronic health record of a large accountable care organization.

Study Design: This is a retrospective cohort design.

Summarized Costs, Placement Of Quality Stars, And Other Online Displays Can Help Consumers Select High-Value Health Plans.

Starting in 2017, all state and federal health insurance exchanges will present quality data on health plans in addition to cost information. We analyzed variations in the current design of information on state exchanges to identify presentation approaches that encourage consumers to take quality as well as cost into account when selecting a health plan. Using an online sample of 1,025 adults, we randomly assigned participants to view the same comparative information on health plans, displayed in different ways.

Adding A Measure Of Patient Self-Management Capability To Risk Assessment Can Improve Prediction Of High Costs.

We explored whether supplementing a clinical risk score with a behavioral measure could improve targeting of the patients most in need of supports that reduce their risk of costly service utilization. Using data from a large health system that determines patient self-management capability using the Patient Activation Measure, we examined utilization of hospital and emergency department care by the 15 percent of patients with the highest clinical risk scores. After controlling for risk scores and placing patients within segments based on their level of activation in 2011, we found that the lower the activation level, the higher the utilization and cost of hospital services in each of the following three years.

Does Compensating Primary Care Providers to Produce Higher Quality Make Them More or Less Patient Centric?

Both payment reform and patient engagement are key elements of health care reform. Yet the question of how incentivizing primary care providers (PCPs) on quality outcomes affects the degree to which PCPs are supportive of patient activation and patient self-management has received little attention. In this mixed-methods study, we use in-depth interviews and survey data from PCPs working in a Pioneer Accountable Care Organization that implemented a compensation model in which a large percentage of PCP salary is based on quality performance.

When patient activation levels change, health outcomes and costs change, too.

Patient engagement has become a major focus of health reform. However, there is limited evidence showing that increases in patient engagement are associated with improved health outcomes or lower costs. We examined the extent to which a single assessment of engagement, the Patient Activation Measure, was associated with health outcomes and costs over time, and whether changes in assessed activation were related to expected changes in outcomes and costs.

How well do patient activation scores predict depression outcomes one year later?

Background: This study examines the relationship between patient activation, a measure of individuals׳ knowledge, skill, and confidence for managing their health, and rates of depression remission and response among patients with depression.

Methods: Patients from Fairview Health Services in Minnesota with moderate to severe depression in 2011 and a PHQ-9 score in 2012 were included in the analysis (n=5253). Patient activation in 2011 and other health and demographic features were extracted from the electronic health record.

Mental health care among low-income pregnant women with depressive symptoms: facilitators and barriers to care access and the effectiveness of financial incentives for increasing care.

Access to mental health care is suboptimal for low-income pregnant women. Using in-depth interviews, we examined barriers and facilitators to accessing care among 42 low income pregnant women with depressive symptoms. To pilot whether financial incentives would increase utilization during pregnancy, half the women were randomized to receive $10 gift cards after mental health visits.

The impact of tobacco dependence treatment coverage and copayments in Medicaid.

Background: The Affordable Care Act (ACA) expands Medicaid's tobacco dependence treatment (TDT) coverage; however, these expansions differ in comprehensiveness based on Medicaid eligibility category.

Purpose: To examine whether more generous Medicaid TDT coverage (in terms of cost-sharing requirements and treatments covered) is associated with greater likelihood of quit attempts and successful quit rates.

Methods: This study used repeated cross-sections from the Current Population Survey (2001-2011), linked to state-level survey data on Medicaid TDT coverage.

When seeing the same physician, highly activated patients have better care experiences than less activated patients.

Measures of the patient care experience are now routinely used in public reports and increasingly influence health provider payment. We examined data from 5,002 patients of forty-nine primary care providers to explore the relationship between patient activation-a term referring to the knowledge, skills, and confidence a patient has for managing his or her health care-and the patient care experience. We found that patients at higher levels of activation had more positive experiences than patients at lower levels seeing the same clinician.

The impact of an online social network with wireless monitoring devices on physical activity and weight loss.

Background: Online social networks (OSNs) are a new, promising approach for catalyzing health-related behavior change. To date, the empirical evidence on their impact has been limited.

Purpose: Using a randomized trial, we assessed the impact of a health-oriented OSN with accelerometer and scales on participant's physical activity, weight, and clinical indicators.