Association of a Geriatric Emergency Department Innovation Program With Cost Outcomes Among Medicare Beneficiaries.

Importance: There has been a significant increase in the implementation and dissemination of geriatric emergency department (GED) programs. Understanding the costs associated with patient care would yield insight into the direct financial value for patients, hospitals, health systems, and payers.

Objective: To evaluate the association of GED programs with Medicare costs per beneficiary.

County-level data on U.S. opioid distributions, demographics, healthcare supply, and healthcare access.

The dataset summarized in this article is a combination of several of U.S. federal data resources for the years 2006-2013, containing county-level variables for opioid pill volumes, demographics (e.

Expert Stakeholder Prioritization of Process Quality Measures to Achieve Patient- and Family-Centered Palliative and End-of-Life Cancer Care.

Quality measures of palliative and end-of-life care relevant to patients with advanced cancer have been developed, but few are in routine use. It is unclear which of these measures are most important for providing patient- and family-centered care and have high potential for improving quality of care. To prioritize process quality measures for assessing delivery of patient- and family-centered palliative and end-of-life cancer care in US Veterans Affairs (VA) health care facilities.

Implications of county-level variation in U.S. opioid distribution.

Background: Prescription opioids accounted for the majority of opioid-related deaths in the United States prior to 2010, and continue to contribute to opioid misuse and mortality. We used a novel dataset to investigate the distributional patterns of prescription opioids, whether opioid pill volume was associated with opioid-related mortality, and whether early state Medicaid expansions were associated with either pill volume or opioid-related mortality.

Methods: Data on opioid shipments to retail pharmacies for 2006-2013 were obtained from the U.

Vector-based kernel weighting: A simple estimator for improving precision and bias of average treatment effects in multiple treatment settings.

Treatment effect estimation must account for observed confounding, in which factors affect treatment assignment and outcomes simultaneously. Ignoring observed confounding risks concluding that a helpful treatment is not beneficial or that a treatment is safe when actually harmful. Propensity score matching or weighting adjusts for observed confounding, but the best way to use propensity scores for multiple treatments is unknown.

Opioid Prescribing and Opioid Risk Mitigation Strategies in the Veterans Health Administration.

Introduction: The Veterans Health Administration (VHA) has taken a multifaceted approach to addressing opioid safety and promoting system-wide opioid stewardship.

Aim: To provide a comprehensive evaluation of current opioid prescribing practices and implementation of risk mitigation strategies in VHA.

Setting: VHA is the largest integrated health care system in the United States.

Opioid Discontinuation Among Patients Receiving High-Dose Long-Term Opioid Therapy in the Veterans Health Administration.

Background: Prior opioid discontinuation studies have focused on one of two characteristics of opioid prescribing, its duration (long term vs not) or dosage (high vs low). Questions remain about the experience of patients with high-dose, long-term opioid therapy (HLOT) prescriptions who are likely to be at the highest risk for adverse events.

Objective: We address the following questions among the Veterans Health Administration (VHA) patients receiving HLOT: 1), How has the prevalence of discontinuation of opioids changed over time? 2), How do patient characteristics vary between those who do and do not discontinue? And 3), how does the prevalence of discontinuation vary geographically?

Design: A retrospective observational study of VHA patients with HLOT between fiscal year (FY) 2014 and FY2018.

Appointment Wait Times for Specialty Care in Veterans Health Administration Facilities vs Community Medical Centers.

This cross-sectional study compares appointment wait times at Veterans Health Administration facilities and those at community medical centers accessed via the Veterans Choice Program.

Medicare's Bundled Payment Initiatives for Hospital-Initiated Episodes: Evidence and Evolution.

Unlabelled: Policy Points Evidence suggests that bundled payment contracting can slow the growth of payer costs relative to fee-for-service contracting, although bundled payment models may not reduce absolute costs. Bundled payments may be more effective than fee-for-service payments in containing costs for certain medical conditions. For the most part, Medicare's bundled payment initiatives have not been associated with a worsening of quality in terms of readmissions, emergency department use, and mortality.

Measure Scan and Synthesis of Palliative and End-of-Life Process Quality Measures for Advanced Cancer.

Purpose: Monitoring and improving the quality of palliative and end-of-life cancer care remain pressing needs in the United States. Among existing measures that assess the quality of palliative and end-of-life care, many operationalize similar concepts. We identified existing palliative care process measures and synthesized these measures to aid stakeholder prioritization that will facilitate health system implementation in patients with advanced cancer.

An Economic Analysis of the Implementation of Team-based Collaborative Care in Outpatient General Mental Health Clinics.

Background: Collaborative Chronic Care Models represent an evidence-based way to structure care for chronic conditions, including mental health conditions. Few studies, however, have examined the cost implications of collaborative care for mental health.

Objective: We aimed to conduct an economic analysis of implementing collaborative care in 9 outpatient general mental health clinics.

Predicting 5- and 10-Year Mortality Risk in Older Adults With Diabetes.

Objective: Several diabetes clinical practice guidelines suggest that treatment goals may be modified in older adults on the basis of comorbidities, complications, and life expectancy. The long-term benefits of treatment intensification may not outweigh short-term risks for patients with limited life expectancy. Because of the uncertainty of determining life expectancy for individual patients, we sought to develop and validate prognostic indices for mortality in older adults with diabetes.

The Relationship Between Follow-up Appointments and Access to Primary Care.

Background: Health care operations managers need to balance scheduling frequent follow-ups for patients with chronic conditions and fitting in patients requiring care for new complaints.

Objective: We quantify how frequency of follow-up visits corresponds with access to care for patients receiving care from the Department of Veterans Affairs (VA).

Design: We use patient data collected between October 2013 and June 2016 by the Survey of Healthcare Experiences of Patients (SHEP).

Transforming Medicare's Payment Systems: Progress Shaped By The ACA.

The Affordable Care Act promoted payment reforms directly and through the creation of the Center for Medicare and Medicaid Innovation, which it endowed with the authority to introduce Alternative Payment Models (APMs) into Medicare and Medicaid. We conducted a narrative review of these payment reforms, finding that several programs generated modest savings while maintaining or improving the quality of care, but they had high dropout rates. In general, evidence for other APMs is less conclusive, and whether the reforms spurred similar changes in the private sector remains anecdotal.

Priority access to health care: Evidence from an exogenous policy shock.

Access to care is an important issue in public health care systems. Unlike private systems, in which price equilibrates supply and demand, public systems often ration medical services through wait times. Access that is given on a first come, first served basis might not yield an allocation of resources that maximizes the health of a population, potentially creating suboptimal heterogeneity in wait times.