The Comprehensive Primary Care Plus Model and Health Care Spending, Service Use, and Quality.

Importance: Implemented in 18 regions, Comprehensive Primary Care Plus (CPC+) was the largest US primary care delivery model ever tested. Understanding its association with health outcomes is critical in designing future transformation models.

Objective: To test whether CPC+ was associated with lower health care spending and utilization and improved quality of care.

Long-Term Effects of the Comprehensive Primary Care Model on Health Care Spending and Utilization.

Background: The Centers for Medicare & Medicaid Services launched the 4-year Comprehensive Primary Care Initiative (CPC Classic) in 2012 and its 5-year successor, CPC Plus (CPC+), in 2017 to test whether improving primary care delivery in five areas-and providing practices with financial and technical support-reduced spending and improved quality. This is the first study to examine long-term effects of a primary care practice transformation model.

Objective: To test whether long-term primary care transformation-the 4-year CPC Classic and the first 2 years of its successor, CPC+-reduced hospitalizations, emergency department (ED) visits, and spending over 6 years.

Measuring physician practice site characteristics: A comparison of data from SK&A and a practice site survey.

Objective: To evaluate the comparability of commercially available practice site data from SK&A with survey data to understand the implications of using SK&A data for health services research.

Data Sources: Responses to the Comprehensive Primary Care Plus (CPC+) Practice Survey and SK&A data.

Study Design: Comparison of CPC + Practice Survey responses to SK&A information for 2698 primary care practice sites.

Participation in the Comprehensive Primary Care Plus Initiative.

Purpose: Comprehensive Primary Care Plus (CPC+) is the largest test of primary care payment and delivery reform. This program aims to strengthen primary care via enhanced and alternative payment, data feedback, learning, and health information technology support for practice transformation for more than 3,000 practices. We analyzed participation rates and how CPC+ practices differ from other primary care practices in CPC+ regions.

Contemporaneous and long-term effects of children's public health insurance expansions on Supplemental Security Income participation.

This study explores the interplay between two important public programs for vulnerable children: Medicaid and the Supplemental Security Income (SSI) program. Children's public health insurance eligibility increased dramatically during the late 1990s with the launch of the Children's Health Insurance Program along with concurrent Medicaid expansions. We use a measure of simulated eligibility as an exogenous source of variation in Medicaid generosity to identify the effects of the eligibility expansions on SSI outcomes.

The Impact of a Health Information Technology-Focused Patient-centered Medical Neighborhood Program Among Medicare Beneficiaries in Primary Care Practices: The Effect on Patient Outcomes and Spending.

Background: The Center for Medicare & Medicaid Innovation (CMMI) tests new models of paying for or delivering health care services and expands models that improve health outcomes while lowering medical spending. CMMI gave TransforMED, a national learning and dissemination contractor, a 3-year Health Care Innovation Award (HCIA) to integrate health information technology systems into physician practices. This paper estimates impacts of TransforMED's HCIA-funded program on patient outcomes and Medicare parts A and B spending.

Impact of Enroll America on the Number of Individuals Covered through the Federally Facilitated Marketplace.

Objective: To assess the impact of Enroll America's field outreach activities on the number of individuals enrolled in Marketplace coverage during the first open enrollment period.

Data Sources/study Setting: Marketplace enrollment for the initial open enrollment period linked with data on Enroll America's field activities and baseline local-area demographic, economic, and health services characteristics.

Study Design: We used a quasi-experimental design, comparing Marketplace enrollment during the first open enrollment period in local areas drawn from Enroll America field states to a comparison group of local areas drawn from states that were not served by Enroll America's field effort, but that otherwise match up well with Enroll America states.

Program Churning and Transfers Between Medicaid and CHIP.

Objective: In the 10 states that are the focus of the Children's Health Insurance Program Reauthorization Act of 2009 evaluation, we analyze in detail the states' recent progress in retaining children in public coverage and public coverage churning.

Methods: We used administrative data spanning a five-and-a-half-year period collected from 10 study states-Alabama, California, Florida, Louisiana, Michigan, New York, Ohio, Texas, Utah, and Virginia-to analyze the extent to which children return to the same program a short time after disenrollment and the extent to which transfers between Medicaid and Children's Health Insurance Program (CHIP) lead to public coverage gaps.

Results: Our analysis yielded 3 key findings.

Stability of children's insurance coverage and implications for access to care: evidence from the Survey of Income and Program Participation.

Even as the number of children with health insurance has increased, coverage transitions--movement into and out of coverage and between public and private insurance--have become more common. Using data from 1996 to 2005, we examine whether insurance instability has implications for access to primary care. Because unobserved factors related to parental behavior and child health may affect both the stability of coverage and utilization, we estimate the relationship between insurance and the probability that a child has at least one physician visit per year using a model that includes child fixed effects to account for unobserved heterogeneity.

Health insurance and access to care among welfare leavers.

This analysis explores the effects of the 1996 welfare reform on health insurance coverage and access to care among former recipients of cash aid. Using panel data from the Women's Employment Study, which conducted five interviews between 1997 and 2003 in one Michigan county, we find that 25% of welfare leavers lacked health insurance coverage in fall 2003. Uninsured adults were significantly more likely than others to report that they could not afford a medical or dental visit during the year prior to the 2003 interview.

The association between maltreatment and obesity among preschool children.

Objective: To determine whether child maltreatment is associated with obesity in preschool children.

Methods: Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children born between 1998 and 2000 in 20 large US cities. At 3 years of age, 2412 of these children had their height and weight measured, and mothers answered items on the Parent-Child Conflict Tactics Scales about three types of child maltreatment--neglect, corporal punishment, and psychological aggression.

The co-occurrence of smoking and a major depressive episode among mothers 15 months after delivery.

Objective: To examine the association between maternal smoking 15 months after delivery and the occurrence of a major depressive episode in the prior 12 months.

Methods: Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study. In 20 U.

Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children.

Objectives: We sought to determine if the prevalence of depression and anxiety in mothers and the prevalence of behavior problems in preschool-aged children are more common when mothers report being food insecure.

Methods: A cross-sectional survey of 2870 mothers of 3-year-old children was conducted in 2001-2003 in 18 large US cities. On the basis of the adult food-security scale calculated from the US Household Food Security Survey Module, mothers were categorized into 3 levels: fully food secure, marginally food secure, and food insecure.

Obesity among US urban preschool children: relationships to race, ethnicity, and socioeconomic status.

Objectives: To determine whether there are racial/ethnic differences in the prevalence of obesity among preschool children and to determine whether these differences are explained by socioeconomic factors.

Design: Cross-sectional assessment.

Setting: Twenty large US cities, from 2001 to 2003.

Maternal mental health, substance use, and domestic violence in the year after delivery and subsequent behavior problems in children at age 3 years.

Context: Mental health disorders, substance use, and domestic violence often occur together. However, studies examining the impact of these conditions in mothers on the well-being of their children have focused only on isolated conditions.

Objective: To examine the cumulative effect of maternal mental health disorders, substance use, and domestic violence on the risk of behavior problems in young children.

Chronic illness, treatment choice and workforce participation.

Choices with respect to labor force participation and medical treatment are increasingly intertwined. Technological advances present patients with new choices and may facilitate continued employment for the growing number of chronically ill individuals. We examine joint work/treatment decisions of end stage renal disease patients, a group for whom these tradeoffs are particularly salient.

Design and analysis of unit cost estimation studies: How many hospital diagnoses? How many countries?

We evaluated three questions that commonly arise when unit costing exercises for multinational trials are conducted: (1). In countries where investigators plan to collect hospital unit cost estimates for a selected set of diagnoses, how should one estimate unit costs for the remaining diagnoses observed in the trial for which cost data were not collected? (2). For how many hospital diagnoses should estimates be obtained? (3).

Economic evaluation of the randomized aldactone evaluation study (RALES): treatment of patients with severe heart failure.

Purpose: To use data from the Randomized Aldactone Evaluation Study (RALES) to compare clinical outcomes and costs as part of the assessment of the economic implications of spironolactone treatment of advanced heart failure.

Methods: RALES was a randomized, double-blinded, placebo-controlled trial that enrolled participants who had severe heart failure and a left ventricular ejection fraction of no more than 35% and who were receiving standard therapy, including an angiotensin-converting enzyme inhibitor, a loop diuretic, and, in some cases, digoxin. We used a decision analytic model that incorporated data from participants in RALES as well as cost data from five countries that participated in the study.

Predictors of loss of residual renal function among new dialysis patients.

Residual renal function (RRF) in end-stage renal disease is clinically important as it contributes to adequacy of dialysis, quality of life, and mortality. This study was conducted to determine the predictors of RRF loss in a national random sample of patients initiating hemodialysis and peritoneal dialysis. The study controlled for baseline variables and included major predictors.