Healthcare utilization and quality among survivors of adolescent and young adult cancer.

2016 ◽  
Vol 34 (3_suppl) ◽  
pp. 21-21
Author(s):  
Anne C. Kirchhoff ◽  
Sapna Kaul ◽  
Mark Fluchel ◽  
Christopher F Parmeter ◽  
Holly Lynn Spraker
Keyword(s):  
Health Care ◽  
Young Adult ◽  
Health Care Quality ◽  
Comparison Group ◽  
Care Quality ◽  
Health Care Use ◽  
Medical Expenditure ◽  
Adolescent And Young Adult ◽  
Care Needs ◽  
Targeted Interventions

21 Background: To evaluate perceived health care quality among a national sample of survivors of adolescent and young adult (AYA) cancer relative to individuals from the general population. Methods: Using the Medical Expenditure Panel Surveys from 2008-2012, we identified 1,163 survivors diagnosed with cancer ages 15-39 who were at least five years from diagnosis and currently ages of 20-64. A comparison group with no history of cancer was created via propensity score matching on sex, age at study, race/ethnicity, census-region, and survey year. Participants with one or more health care visit in the past 12 months were asked to rate health care quality from all providers (0 = worst to 10 = best), which we categorized as low (0-4), moderate (5-7) and high (8-10). Among survivors, we identified factors such insurance and health status associated with health care quality using ordinal logistic regression. Results: Mean time since diagnosis was 18.3 years. A total of 18% of survivors of AYA cancer reported no health care visits in the previous 12 months compared to 25% of the comparison group (p < 0.001). Survivors rated their health care quality lower than the comparison group (low/moderate: 30.8% vs. 22.5%, respectively, p = 0.003). Among survivors, those who were publicly insured (odds ratio (OR) = 0.62, 95% confidence interval (CI): 0.39-0.97, p = 0.04) and uninsured (OR = 0.25, 95% CI: 0.13-0.48, p < 0.001) were more likely to provide lower health care quality ratings than privately insured survivors. Survivors in fair/poor health also reported poorer quality compared to those in excellent/very good/good health (OR = 0.43, 95% CI, p < 0.001). Conclusions: Survivors of AYA cancer reported greater health care use and poorer health care quality compared to individuals without cancer. Our results call for targeted interventions to meet AYA cancer survivors’ health care needs and expectations.

Health Care of Latino Children with Autism and Other Developmental Disabilities: Quality of Provider Interaction Mediates Utilization

2012 ◽  
Vol 117 (4) ◽  
pp. 304-315 ◽  
Author(s):  
Susan Parish ◽  
Sandra Magaña ◽  
Roderick Rose ◽  
Maria Timberlake ◽  
Jamie G Swaine
Keyword(s):  
Health Care ◽  
Developmental Disabilities ◽  
Health Care Utilization ◽  
Health Care Quality ◽  
Children With Autism ◽  
Care Quality ◽  
Care Utilization ◽  
Latino Children ◽  
Care Needs

Abstract This study examines access to, utilization of, and quality of health care for Latino children with autism and other developmental disabilities. We analyze data from the National Survey of Children with Special Health Care Needs (N  =  4,414 children with autism and other developmental disabilities). Compared with White children, Latino children with autism and other developmental disabilities had a consistent pattern of worse health care access, utilization, and quality. We then test mediation models to determine if health care quality mediates the relationship between ethnicity and health care utilization disparities. Three of four quality indicators (provider does not spend enough time with child, provider is not culturally sensitive, and provider does not make parent feel like a partner) were significant mediators. These analyses suggest that interventions targeted at improving providers' cultural sensitivity and behavior during the clinical encounter may reduce disparities in the health care utilization of Latino children with autism and other developmental disabilities.

How Do We Align Health Services Research and Quality Improvement?

2020 ◽  
pp. 282-291
Author(s):  
Devika Das ◽  
Lalan Wilfong ◽  
Katherine Enright ◽  
Gabrielle Rocque
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Health Services Research ◽  
Health Services ◽  
Health Care Quality ◽  
Care Delivery ◽  
Care Quality ◽  
Health Care Use ◽  
Semistructured Interview ◽  
Services Research

Quality improvement (QI) initiatives and health services research (HSR) are commonly used to target health care quality. These disciplines are increasingly important because of the movement toward value-based health care as alternative payment and care delivery models drive institutions and investigators to focus on reducing unnecessary health care use and improving care coordination. QI efforts frequently target medical error and/or efficiency of care through the Plan-Do-Study-Act methodology. Within the QI framework, strategies for data display (e.g., Pareto charts, run charts, histograms, scatter plots) are leveraged to identify opportunities for intervention and improvement. HSR is a multidisciplinary field of study that seeks to identify the most effective way to organize, deliver, and finance health care to maximize the quality and value of care at both the individual and population levels. HSR uses a diverse set of quantitative and qualitative methodologies, such as case-control studies, cohort studies, randomized control trials, and semistructured interview/focus group evaluations. This manuscript provides examples of methodologic approaches for QI and HSR, discusses potential challenges associated with concurrent quality efforts, and identifies strategies to successfully leverage the strengths of each discipline in care delivery.

Capitation, Advances in Medical Technology, and the Advent of a New Era in Medical Ethics

1996 ◽  
Vol 22 (2-3) ◽  
pp. 331-360 ◽  
Author(s):  
Michael J. Malinowski
Keyword(s):  
Health Care ◽  
Health Care Quality ◽  
The United States ◽  
Care Quality ◽  
Care Needs ◽  
New Era ◽  
For Profit ◽  
Zero Sum ◽  
The Impact ◽  
Care Costs

Health care is being capitated throughout the United States, and much of the spread of capitation is attributable to the efforts of insurers to contain costs. The present lack of comprehensive studies evaluating the impact of capitation on overall health care quality leaves vast room for speculation.Capitation does, however, carry a very fundamental certainty with broad implications. Whether the arrangement calls for a fixed sum for treating a particular ailment, a set fee for meeting all of an individual patient’s health care needs, or a standard charge for supplying all the medication for a specific condition, capitation sets limits. Because the health care costs for any given patient or condition are in reality zero-sum rather than fixed, capitation is about pooling patients and rationing. It involves denying services to some patients despite a general contractual commitment to coverage, presumably so that more patients can be covered or receive better care. The implications of capitation are even more significant when set fully in the context of the overall health care reform now underway. Simultaneously and comprehensively, health care is being managed, made for-profit, and consolidated.

Fiscal difficulties of cities, the labor market, and health care

2018 ◽  
Vol 18 (04) ◽  
pp. 565-578
Author(s):  
John Hsu ◽  
Joseph Newhouse ◽  
Lindsay Nicole Overhage ◽  
Samuel Zuvekas
Keyword(s):  
Health Care ◽  
Comparison Group ◽  
Medical Expenditure Panel Survey ◽  
Health Care Use ◽  
Medical Expenditure ◽  
Panel Survey ◽  
Public Employment ◽  
Bond Ratings ◽  
Reported Health ◽  
Group Self

AbstractWe investigated labor force and health outcomes in cities experiencing fiscal difficulties to assess how those difficulties might impact their employees. We matched 23 cities with bond downgrades and 31 cities with stable bond ratings to sampling units in the Medical Expenditure Panel Survey. Starting the year before the downgrade and for the four subsequent years, the rate of separation from local public employment fell in the cities with downgrades relative to the comparison group. Self-reported health may have worsened, but there were no statistically significant effects on health care use or spending.

scholarly journals Rapid-Learning System for Cancer Care

2010 ◽  
Vol 28 (27) ◽  
pp. 4268-4274 ◽  
Author(s):  
Amy P. Abernethy ◽  
Lynn M. Etheredge ◽  
Patricia A. Ganz ◽  
Paul Wallace ◽  
Robert R. German ◽  
...  
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Cancer Care ◽  
Health Care Quality ◽  
Scientific Discovery ◽  
Care Quality ◽  
Learning System ◽  
Control Measures ◽  
Care Needs ◽  
Rapid Learning

Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is “rapid-learning health care.” In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled “A Foundation for Evidence-Driven Practice: A Rapid-Learning System for Cancer Care” in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action.

Impacts of Maryland’s Global Budgets on Medicare and Commercial Spending and Utilization

2020 ◽  
pp. 107755872095469
Author(s):  
Marisa Morrison ◽  
Susan Haber ◽  
Heather Beil ◽  
Katherine Giuriceo ◽  
Katherine Sapra
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Health Care Quality ◽  
Comparison Group ◽  
Care Quality ◽  
Difference In Differences ◽  
Total Spending ◽  
Global Budgets ◽  
Spending Growth ◽  
Improve Health

In 2014, Maryland incorporated global budgets into its long-running all-payer rate-setting model for hospitals in order to improve health, increase health care quality, and reduce spending. We used difference-in-differences models to estimate changes in Medicare and commercial insurance utilization and spending in Maryland relative to a hospital-based comparison group. We found slower growth in Medicare hospital spending in Maryland than in the comparison group 4.5 years after model implementation and for commercial plan members after 4 years. We identified reductions in Maryland Medicare admissions but no changes for commercial plan members, although their inpatient spending declined. Relative declines in emergency department and other hospital outpatient spending in Maryland drove slower Medicare hospital spending growth, saving $796 million. Our findings suggest global budgets reduce hospital spending and utilization but aligning incentives between hospital and nonhospital providers may be necessary to further reduce utilization and total spending.

Quality Measures for Children’s Health Care

PEDIATRICS ◽  
2004 ◽  
Vol 113 (Supplement_1) ◽  
pp. 199-209 ◽  
Author(s):  
Anne C. Beal ◽  
John Patrick T. Co ◽  
Denise Dougherty ◽  
Tanisha Jorsling ◽  
Jeanelle Kam ◽  
...  
Keyword(s):  
Health Care ◽  
Child Health ◽  
End Of Life ◽  
Health Care Quality ◽  
Quality Measures ◽  
Care Quality ◽  
Children's Health ◽  
Children’S Health ◽  
Care Needs ◽  
Children’S Health Care

Background. The ability to measure and improve the quality of children’s health care is of national importance. Despite the existence of numerous health care quality measures, the collective ability of measures to assess children’s health care quality is unclear. A review of existing health care quality measures for children is timely for both assessing the current state of quality measures for children and identifying areas requiring additional research and development. Objectives. To identify and collect current health care quality measures for child health and then to systematically categorize and classify measures and identify gaps in child health care quality measures requiring additional development. Design/Methods. We first identified child health care quality instruments with assistance from staff at the Agency for Healthcare Research and Quality, experts in the field, the Computerized Needs-oriented Quality Measurement Evaluation System, the Child and Adolescent Health Measurement Initiative, and a medical literature review. From these instruments, we then selected clinical performance measures applicable to children (aged 0–18 years). We categorized the individual measures into the Institute of Medicine’s framework for the National Health Care Quality Report. The framework includes health care quality domains (patient safety, effectiveness, patient-centeredness, and timeliness) and patient-perspective domains (staying healthy, getting better, living with illness, and end-of-life care). We then determined the balance of the measures (how well they assess care for all children versus children with special health care needs) and their comprehensiveness (how well the measures apply to the developmental range of children). Finally, we analyzed the ability of the measures to assess equity in care. Results. We identified 19 measure sets, and 396 individual measures were used to assess children’s health care quality. The distribution of measures in the health care quality domains was: safety, 14.4%; effectiveness, 59.1%; patient-centeredness, 32.1%; and timeliness, 33.3%. The distribution of measures in the patient-perspective domains was: staying healthy, 24%; getting better, 40.2%; living with illness, 17.4%; end of life, 0%; and multidimensional, 23.5% (measures were multidimensional if they applied to &gt;1 domain). Most of the measures were meant for use in the general pediatric population (81.1%), with a significant proportion designed for children with special health care needs (18.9%). The majority (≥79%) of the measures could be applied to children across all age groups. However, there were relatively few measures designed specifically for each developmental stage. Regarding the use of measures to study equity in health care, 6 of the measure sets have been used in previous studies of equity. All the survey measure sets contain items that identify patients at risk for poor outcomes, and 4 are available in languages other than English. However, only 1 survey (Consumer Assessment of Health Plans) has undergone studies of cross-cultural validation. Among the measure sets based on administrative data, 3 included infant mortality, a well-known measure of health disparity. Conclusions. There are several instruments designed to measure health care quality for children. Despite this, we found relatively few measures for assessing patient safety and living with illness and none for end-of-life care. Few measures are designed for specific age categories among children. Although equity is an overarching concern in health care quality, the application of current measures to assess disparities has been limited. These areas need additional research and development for a more complete assessment of health care quality for children.

Sign in / Sign up

Export Citation Format

Share Document