Hotspotting in home health: The impact of interprofessional student-team home visits on readmission rates of super-utilizers of the health care system

OBJECTIVESeveral similarities exist between the Massachusetts health care reform law of 2006 and the Affordable Care Act (ACA). The authors’ prior neurosurgical research showed a decrease in uninsured surgeries without a significant change in surgical volume after the Massachusetts reform. An analysis of the payer-mix status and the age of spine surgery patients, before and after the policy, should provide insight into the future impact of the ACA on spine surgery in the US.METHODSUsing the Massachusetts State Inpatient Database and spine ICD-9-CM procedure codes, the authors obtained demographic information on patients undergoing spine surgery between 2001 and 2012. Payer-mix status was assigned as Medicare, Medicaid, private insurance, uninsured, or other, which included government-funded programs and workers’ compensation. A comparison of the payer-mix status and patient age, both before and after the policy, was performed. The New York State data were used as a control.RESULTSThe authors analyzed 81,821 spine surgeries performed in Massachusetts and 248,757 in New York. After 2008, there was a decrease in uninsured and private insurance spine surgeries, with a subsequent increase in the Medicare and “other” categories for Massachusetts. Medicaid case numbers did not change. This correlated to an increase in surgeries performed in the age group of patients 65–84 years old, with a decrease in surgeries for those 18–44 years old. New York showed an increase in all insurance categories and all adult age groups.CONCLUSIONSAfter the Massachusetts reform, spine surgery decreased in private insurance and uninsured categories, with the majority of these surgeries transitioning to Medicare. Moreover, individuals who were younger than 65 years did not show an increase in spine surgeries, despite having greater access to health insurance. In a health care system that requires insurance, the decrease in private insurance is primarily due to an increasing elderly population. The Massachusetts model continues to show that this type of policy is not causing extreme shifts in the payer mix, and suggests that spine surgery will continue to thrive in the current US health care system.

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The Impact of Age on Colorectal Cancer Incidence, Treatment, and Outcomes in an Equal-Access Health Care System

Diseases of the Colon & Rectum ◽

10.1097/dcr.0b013e3182a586e7 ◽

2014 ◽

Vol 57 (3) ◽

pp. 303-310 ◽

Cited By ~ 33

Author(s):

Scott R. Steele ◽

Grace E. Park ◽

Eric K. Johnson ◽

Matthew J. Martin ◽

Alexander Stojadinovic ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Health Care System ◽

Cancer Incidence ◽

Equal Access ◽

Colorectal Cancer Incidence ◽

The Impact ◽

Care System

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The Impact of Ventilator-Associated Pneumonia on the Canadian Health Care System

Survey of Anesthesiology ◽

10.1097/01.sa.0000358589.57457.b8 ◽

2009 ◽

Vol 53 (5) ◽

pp. 200

Author(s):

&NA;

Keyword(s):

Health Care ◽

Health Care System ◽

Ventilator Associated Pneumonia ◽

Canadian Health Care System ◽

Canadian Health ◽

Canadian Health Care ◽

The Impact ◽

Care System

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Novel Use of a Nurse-Led Telemedicine Team in Acute Stroke: A Retrospective Review of the Impact on a Regional Health Care System

Journal of Emergency Nursing ◽

10.1016/j.jen.2018.07.026 ◽

2019 ◽

Vol 45 (3) ◽

pp. 242-248 ◽

Cited By ~ 1

Author(s):

Susan B. Fowler ◽

Christian A. Rosado ◽

Jennifer Jones ◽

Suzanne Ashworth ◽

Darlene Adams

Keyword(s):

Health Care ◽

Acute Stroke ◽

Health Care System ◽

Retrospective Review ◽

Regional Health ◽

Regional Health Care ◽

The Impact ◽

Care System

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Patient Experiences, Trust, and Preferences for Health Data Sharing

JCO Oncology Practice ◽

10.1200/op.21.00491 ◽

2021 ◽

Author(s):

Rochelle D. Jones ◽

Chris Krenz ◽

Kent A. Griffith ◽

Rebecca Spence ◽

Angela R. Bradbury ◽

...

Keyword(s):

Health Care ◽

Data Sharing ◽

Health Care System ◽

Lived Experiences ◽

Care Delivery ◽

Group Discussion ◽

Final Analysis ◽

Secondary Use ◽

The Impact ◽

Care System

PURPOSE: Scholars have examined patients' attitudes toward secondary use of routinely collected clinical data for research and quality improvement. Evidence suggests that trust in health care organizations and physicians is critical. Less is known about experiences that shape trust and how they influence data sharing preferences. MATERIALS AND METHODS: To explore learning health care system (LHS) ethics, democratic deliberations were hosted from June 2017 to May 2018. A total of 217 patients with cancer participated in facilitated group discussion. Transcripts were coded independently. Finalized codes were organized into themes using interpretive description and thematic analysis. Two previous analyses reported on patient preferences for consent and data use; this final analysis focuses on the influence of personal lived experiences of the health care system, including interactions with providers and insurers, on trust and preferences for data sharing. RESULTS: Qualitative analysis identified four domains of patients' lived experiences raised in the context of the policy discussions: (1) the quality of care received, (2) the impact of health care costs, (3) the transparency and communication displayed by a provider or an insurer to the patient, and (4) the extent to which care coordination was hindered or facilitated by the interchange between a provider and an insurer. Patients discussed their trust in health care decision makers and their opinions about LHS data sharing. CONCLUSION: Additional resources, infrastructure, regulations, and practice innovations are needed to improve patients' experiences with and trust in the health care system. Those who seek to build LHSs may also need to consider improvement in other aspects of care delivery.

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Reduction in Diabetes-Related Major Amputation Rates After Implementation of a Multidisciplinary Model: An Evaluation in Alberta, Canada

Journal of the American Podiatric Medical Association ◽

10.7547/19-137 ◽

2019 ◽

pp. 0000-0000 ◽

Cited By ~ 2

Author(s):

Reza Basiri ◽

Brent D. Haverstock ◽

Paul F. Petrasek ◽

Karim Manji

Keyword(s):

Health Care ◽

Health Care System ◽

Pearson Correlation ◽

Significant Negative Correlation ◽

Major Amputation ◽

Incidence Rates ◽

Positive Sign ◽

Supporting Evidence ◽

The Impact ◽

Care System

BACKGROUND: Lower limb amputations (LLAs) are a major debilitating complication of diabetes. The toe and flow model (TFM) describes the framework for multidisciplinary centers aiming to reduce this complication. In this study, we investigate the efficacy of the TFM to reduce diabetes-related major LLAs in comparison with the standard of care (SOC) in the Canadian health care system. METHODS: We retrospectively reviewed the anonymized diabetes-related LLA reports in two similar metropolitan health zones in Alberta, Canada from 2007 to 2017. Although both zones have the same provincial health care system and similar demographics, Calgary, our first zone operates on the basis of the TFM while the Edmonton zone operates in accordance with the provincial SOC. LLAs were divided into minor and major amputation cohorts. We used the chi-square test, linear regression, and Pearson correlation for analysis. The lower proportion of major LLAs was denoted as a positive sign for the efficacy of the TFM. RESULTS: Although the number of LLAs remained relatively comparable (Calgary zone: 2238 and Edmonton zone: 2410), the Calgary zone had both significantly lower major (45%) and higher minor (42%) amputation incidence rates compared to the Edmonton zone. The increasing trend in minor LLAs and decreasing trend in major LLAs in the Calgary zone were negatively and significantly correlated (r = -0.730, p = 0.011). No significant correlation was found in the Edmonton zone. CONCLUSIONS: A significant reduction in the incidence rate, decreasing trend of diabetes-related major LLAs and the significant negative correlation of minor and major LLAs rates in the Calgary zone (TFM) compared to its sister zone Edmonton (SOC), provides supporting evidence for the impact of the TFM. This investigation provides support for a modernization of the diabetes-related limb preservation practice in Canada through the implementation of TFMs across the country to combat major LLAs.

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Book Reviews: Coddington et al. - The Crisis in Health Care: Costs, Choices, and StrategiesDean C. Coddington, David J. Keen, Keith D. Moore, and Richard L. Clarke San Francisco: Jossey-Bass, 1991, 303 pp. US$30.95 cloth. ISBN 1-55542-273-X. Jossey-Bass Publishers, 350 Sansome St., San Francisco, CA 94104, USA.

Politics and the Life Sciences ◽

10.1017/s073093840001532x ◽

1992 ◽

Vol 11 (2) ◽

pp. 274-275

Author(s):

Andrea L. Bonnicksen

Keyword(s):

Health Care ◽

San Francisco ◽

Health Care System ◽

The United States ◽

Economic Research ◽

Present System ◽

Cost Shifting ◽

Hospital Administrators ◽

The Impact ◽

Care System

PrécisThe authors assume that costs can no longer be contained in the United States health care system and that the present system cannot be sustained beyond the near future. Three of the authors are affiliated with an applied economic research and consulting firm, and the fourth is president of the Healthcare Financial Management Association. They are trained in business and city planning. The bibliography lists articles from such journals as Hospitals, Business & Health, Business Insurance, and Medical Economics.The book is directed to members of hospital governing boards and other hospital administrators, but it will be of interest to students of health policy. Part I highlights tensions between what the authors call the worlds of doctors and hospital administrators struggling to survive, on the one hand, and health care planners worried about spiraling costs on the other. Part II contains five chapters that suggest reasons for growing costs and that criticize cost shifting as a remedy.In Part III the authors evaluate alternative health care systems by presenting four future scenarios: incremental change, universal access, consumer choice model, and single payer system. In these chapters they also approach the fundamental purpose of the book—to “help physicians, hospitals, and health plans take the next steps to position themselves for the future.” While not highly analytical, the book is a readable and thoughtful supplement to more abstract critiques of the impact of today's health care system on distributive justice.

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