HAC-POA policy effects on hospitals, other payers, and patients.

Background: Prior to the implementation of the Hospital-Acquired Condition-Present on Admission (HAC-POA) payment policy, concerns regarding its potential impact were raised by a number of organizations and individuals. The purpose of this study was to explore direct and indirect effects of the HAC-POA payment policy on hospitals, patients, and other payers during the policy's first 3 years of implementation.

Methods: The study included semi-structured telephone interviews with representatives of national organizations, hospitals, patient advocacy organizations, and other payers.

Hospices' use of electronic medical records for quality assessment and performance improvement programs.

Context: Electronic medical records (EMRs) are increasingly viewed as essential tools for quality assurance and improvement in many care settings, but little is known about the use of EMRs by hospices in their quality assessment and performance improvement (QAPI) programs.

Objectives: To examine the data sources hospices use to create quality indicators (QIs) used in their QAPI programs and to examine the domains of EMR-based QIs.

Methods: We used self-reported QIs (description, numerator, and denominator) from 911 hospices nationwide that participated in the Centers for Medicare & Medicaid Services nationwide hospice voluntary reporting period.

Accelerating what works: using qualitative research methods in developing a change package for a learning collaborative.

Background: Learning (quality improvement) collaboratives are effective vehicles for driving coordinated organizational improvements. A central element of a learning collaborative is the change package-a catalogue of strategies, change concepts, and action steps that guide participants in their improvement efforts. Despite a vast literature describing learning collaboratives, little to no information is available on how the guiding strategies, change concepts, and action items are identified and developed to a replicable and actionable format that can be used to make measurable improvements within participating organizations.

Strategies for safe medication use in ambulatory care settings in the United States.

Objective: This study aims to identify strategies for safe medication use practices in ambulatory care settings, with a special focus on clinical pharmacy services.

Methods: We conducted case studies on 34 organizations, more than half of which were safety net providers. Data included discussions with 186 key informants, 3 interim debriefings, and a technical expert panel.

Physicians' views on public reporting of hospital quality data.

This article describes physicians' responses to patient questions and physicians' views about public reports on hospital quality. Interviews with 56 office-based physicians in seven states/regions used hypothetical scenarios of patients questioning referrals based on public reports of hospital quality. Responses were analyzed using an iterative coding process to develop categories and themes from data.

Perspectives on the state-of-the-science in rehabilitation medicine and its implications for Medicare postacute care policies.

Better measurement of the case-mix complexity of patients receiving rehabilitation services is critical to understanding variations in the outcomes achieved by patients treated in different postacute care (PAC) settings. The Medicare program recognized this issue and is undertaking a major initiative to develop a new patient-assessment instrument that would standardize case-mix measurement in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies. The new instrument, called the Continuity Assessment Record and Evaluation Tool, builds on the scientific advances in measurement to develop standard measures of medical acuity, functional status, cognitive impairment, and social support related to resource need, outcomes, and continuity of care for use in all PAC settings.

Problem-oriented reporting of CAHPS consumer evaluations of health care.

Consumer Assessment of Health Care Providers and Systems (CAHPS) is an organized effort to provide consumers with standardized, comprehensible, and usable data regarding consumers' experiences with health care. In its Medicare and other summary reports, CAHPS emphasizes the frequency of the most positive experiences. Cognitive models of survey response combined with attitude theory suggest that performance measurement might be further improved by the addition of problem-oriented reporting, which highlights the frequency of negative experiences.

Specialty versus community hospitals: referrals, quality, and community benefits.

In this paper we compare physician referral patterns, quality, patient satisfaction, and community benefits of physician-owned specialty versus peer competitor hospitals. Our results are based on evidence gathered from site visits to six markets, 2003 Medicare claims, patient focus groups, and Internal Revenue Service data. Although physician-owners are more likely than others to refer to their own facilities and treat a healthier population, there are rationales for these patterns aside from motives for profit.

Comparison of performance of traditional Medicare vs Medicare managed care.

Context: Since 2000, the Centers for Medicare & Medicaid Services (CMS) has been collecting information on beneficiaries' experiences with health care for Medicare managed care (MMC) and traditional fee-for-service (FFS) Medicare.

Objectives: To compare beneficiary experiences with managed care and FFS arrangements throughout the country and to assess the stability of those differences over time.

Design, Setting, And Participants: CMS administered managed care and FFS versions of the Consumer Assessment of Health Plans Study (CAHPS) survey to samples of beneficiaries (aged > or =65 years) from Medicare + Choice MMC organizations and from geographic strata within the traditional FFS Medicare program.

How do integrated delivery systems adopt and implement clinical information systems?

We examined how five integrated delivery systems make decisions about and implement clinical information systems. Using case study methods, we identified general themes and explored how organizational context factors and information technology characteristics affect adoption and implementation processes.