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1.
Am J Manag Care ; 26(2): 59-60, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32059091

RESUMEN

The authors of "CMS HCC Risk Scores and Home Health Patient Experience Measures" respond to a letter to the editor.

2.
J Rural Health ; 2020 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-32022948

RESUMEN

PURPOSE: To examine the differences in quality performance among agencies in urban areas and those in high utilization, low population density, and all other rural areas, defined in the Bipartisan Budget Act (BBA). METHODS: We conducted a retrospective study using 2015 data: the Home Health Compare, the Home Health Agency Utilization and Payment Use, the Provider of Services, and the Area Health Resources Files, and a file with rural categories in BBA. The quality measures included (1) hospitalizations, (2) emergency visits, (3) patient experience, (4) composite scores for improvement in activities of daily living (ADL), (5) improvement in pain and treating symptoms, (6) preventing harm, and (7) treating wounds and preventing pressure sores. We applied weighted least squares regression. FINDINGS: Among all quality measures, differences in emergency visits of the 3 rural categories from urban agencies were the largest. The adjusted mean emergency visit for urban agencies was 12.42%, with agencies in rural areas having 1.01-1.96 percentage points higher rates than urban agencies (95% CI: 0.72-1.29 for high utilization areas, 95% CI: 0.51-3.42 for low population areas, and 95% CI: 1.28-1.78 for all other areas). CONCLUSIONS: The differences in the quality of care among agencies in 3 categories of rural areas were small, except for emergency visits. Given policies to reduce rural add-on payments for home health services, continued monitoring of the services provided and the quality of care by home health agencies in rural areas is recommended.

3.
Med Care ; 2020 Feb 07.
Artículo en Inglés | MEDLINE | ID: mdl-32040039

RESUMEN

BACKGROUND: Rates of low-birth weight and prematurity vary 2-fold across states in the United States, with increased rates among states with higher concentrations of racial minorities. Medicaid expansion may serve as a mechanism to reduce geographic variation within states that expanded, by improving health and access to care for vulnerable populations. OBJECTIVE: The objective of this study was to identify the association of Medicaid expansion with changes in county-level geographic variation in rates of low-birth weight and preterm births, overall and stratified by race/ethnicity. RESEARCH DESIGN: We compared changes in the coefficient of variation and the ratio of the 80th-to-20th percentiles using bootstrap samples (n=1000) of counties drawn separately for all births and for white, black, and Hispanic births, separately. MEASURES: County-level rates of low-birth weight and preterm birth. RESULTS: Before Medicaid expansion, counties in expansion states were concentrated among quintiles with lower rates of adverse birth outcomes and counties in nonexpansion states were concentrated among quintiles with higher rates. In expansion states, county-level variation, measured by the coefficient of variation, declined for both outcomes among all racial/ethnic categories. In nonexpansion states, geographic variation reduced for both outcomes among Hispanic births and for low-birth weight among white births, but increased for both outcomes among black births. CONCLUSIONS: The decrease in county-level variation in adverse birth outcomes among expansion states suggests improved equity in these states. Further reduction in geographic variation will depend largely on policies or interventions that reduce racial disparities in states that did and did not expand Medicaid.

5.
JAMA ; 321(16): 1598-1609, 2019 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-31012935

RESUMEN

Importance: Low birth weight and preterm birth are associated with adverse consequences including increased risk of infant mortality and chronic health conditions. Black infants are more likely than white infants to be born prematurely, which has been associated with disparities in infant mortality and other chronic conditions. Objective: To evaluate whether Medicaid expansion was associated with changes in rates of low birth weight and preterm birth outcomes, both overall and by race/ethnicity. Design, Setting, and Participants: Using US population-based data from the National Center for Health Statistics Birth Data Files (2011-2016), difference-in-differences (DID) and difference-in-difference-in-differences (DDD) models were estimated using multivariable linear probability regressions to compare birth outcomes among infants in Medicaid expansion states relative to non-Medicaid expansion states and changes in relative disparities among racial/ethnic minorities for singleton live births to women aged 19 years and older. Exposures: State Medicaid expansion status and racial/ethnic category. Main Outcomes and Measures: Preterm birth (<37 weeks' gestation), very preterm birth (<32 weeks' gestation), low birth weight (<2500 g), and very low birth weight (<1500 g). Results: The final sample of 15 631 174 births (white infants: 8 244 924, black infants: 2 201 658, and Hispanic infants: 3 944 665) came from the District of Columbia and 18 states that expanded Medicaid (n = 8 530 751) and 17 states that did not (n = 7 100 423). In the DID analyses, there were no significant changes in preterm birth in expansion relative to nonexpansion states (preexpansion to postexpansion period, 6.80% to 6.67% [difference: -0.12] vs 7.86% to 7.78% [difference: -0.08]; adjusted DID: 0.00 percentage points [95% CI, -0.14 to 0.15], P = .98), very preterm birth (0.87% to 0.83% [difference: -0.04] vs 1.02% to 1.03% [difference: 0.01]; adjusted DID: -0.02 percentage points [95% CI, -0.05 to 0.02], P = .37), low birth weight (5.41% to 5.36% [difference: -0.05] vs 6.06% to 6.18% [difference: 0.11]; adjusted DID: -0.08 percentage points [95% CI, -0.20 to 0.04], P = .20), or very low birth weight (0.76% to 0.72% [difference: -0.03] vs 0.88% to 0.90% [difference: 0.02]; adjusted DID: -0.03 percentage points [95% CI, -0.06 to 0.01], P = .14). Disparities for black infants relative to white infants in Medicaid expansion states compared with nonexpansion states declined for all 4 outcomes, indicated by a negative DDD coefficient for preterm birth (-0.43 percentage points [95% CI, -0.84 to -0.02], P = .05), very preterm birth (-0.14 percentage points [95% CI, -0.26 to -0.02], P = .03), low birth weight (-0.53 percentage points [95% CI, -0.96 to -0.10], P = .02), and very low birth weight (-0.13 percentage points [95% CI, -0.25 to -0.01], P = .04). There were no changes in relative disparities for Hispanic infants. Conclusions and Relevance: Based on data from 2011-2016, state Medicaid expansion was not significantly associated with differences in rates of low birth weight or preterm birth outcomes overall, although there were significant improvements in relative disparities for black infants compared with white infants in states that expanded Medicaid vs those that did not.


Asunto(s)
Disparidades en el Estado de Salud , Recién Nacido de Bajo Peso , Cobertura del Seguro , Medicaid , Nacimiento Prematuro , Grupos de Población Continentales , Femenino , Hispanoamericanos , Humanos , Recién Nacido , Modelos Lineales , Masculino , Gobierno Estatal , Estados Unidos
6.
Pharmacoeconomics ; 37(4): 461-473, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30953263

RESUMEN

Spillover effects on the welfare of family members may refer to caregiver health effects, informal care time costs, or both. This review focuses on methods that have been used to measure and value informal care time and makes suggestions for their appropriate use in cost-of-illness and cost-effectiveness analyses. It highlights the importance of methods to value informal care time that are independent of caregiver health effects in order to minimize double counting of spillover effects. Although the concept of including caregiver time costs in economic evaluations is not new, relatively few societal perspective cost-effectiveness analyses have included informal care, with the exception of dementia. This is due in part to challenges in measuring and valuing time costs. Analysts can collect information on time spent in informal care or can assess its impact in displacing other time use, notably time in paid employment. A key challenge is to ensure appropriate comparison groups that do not require informal care to be able to correctly estimate attributable informal care time or foregone market work. To value informal care time, analysts can use estimates of hourly earnings in either opportunity cost or replacement cost approaches. Researchers have used widely varying estimates of hourly earnings. Alternatively, stated-preference methods (i.e. contingent valuation, conjoint analysis) can be used to value the effect of informal care on utility, but this can entail double counting with health effects. Lack of consensus and standardization of methods makes it difficult to compare estimates of informal care costs.

7.
Pharmacoeconomics ; 37(4): 609-620, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30864066

RESUMEN

BACKGROUND AND OBJECTIVE: Healthcare interventions that improve the health of children with autism spectrum disorder (ASD) have the potential to affect the health of caregivers. This study compares the three-level EuroQoL-5 Dimension (EQ-5D-3L) and the Short Form-6 Dimension (SF-6D) in their ability to value such spillover effects in caregivers. METHODS: Clinical data collected from two Autism Treatment Network (ATN) sites was combined with survey data of caregivers of children diagnosed with ASD. Caregivers completed instruments by proxy describing child health and completed the EQ-5D-3L and SF-6D preference-weighted instruments to describe their own health. RESULTS: There was a strong correlation between the health utility scores of the two preference-weighted instruments (ρ = 0.6172, p < 0.001) measuring caregiver health-related quality of life. There was a similar correlation between both the SF-6D and EQ-5D-3L scores with a previously validated care-related quality of life measure (Care-related Quality of Life instrument [CarerQol-7D]) (ρ = 0.569, p < 0.001 and ρ = 0.541, p < 0.001, respectively). The mean SF-6D scores for caregivers differed significantly in relation to four of the five child health or behavior measures whereas the EQ-5D-3L differed for only two of them. CONCLUSIONS: Health utility values of caregivers for children with ASD vary by the health characteristics of the child, suggesting significant potential for spillover effects. The comparison of the EQ-5D-3L and SF-6D demonstrated that both instruments can be used to estimate spillover effects of interventions to improve child health, but the SF-6D exhibited greater sensitivity to child health among children with ASD.

8.
Matern Child Health J ; 23(5): 704-709, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30729362

RESUMEN

The original version of this article unfortunately contained a mistake in the analysis of the Tables 4 and 5.

9.
Am J Manag Care ; 24(10): e319-e324, 2018 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-30325193

RESUMEN

OBJECTIVES: To understand the association between agency-level CMS Hierarchical Condition Categories (HCC) risk scores and patient experience measures for home health. STUDY DESIGN: This was a cross-sectional study. METHODS: We extracted variables from the 2014 Medicare Provider Utilization and Payment Data for Home Health Agencies and Home Health Compare file. We applied fixed-effects models for the analyses. Our dependent variables included both global and composite patient experience measures. The 2 global patient experience measures were the patient's overall rating of care provided by the agency (rating) and the patient's willingness to recommend the home health agency to others (recommendation). The 3 composite patient experience measures were how often the patient felt the provider gave care in a professional way (professional way), how well the home health team communicated with the patient (communication), and whether the home health team discussed medicines, pain, and home safety with the patient (discussion). RESULTS: Increased agency-level CMS HCC risk scores were negatively associated with all patient experience measures: rating (-2.04; P ≤.001), recommendation (-2.75; P <.001), professional way (-1.56; P <.001), communication (-1.67; P <.001), and discussion (-1.69; P ≤.001). Several covariates, including the percentage of racial/ethnic minority beneficiaries, ownership of the agency, and number of tenured years with the Medicare program, were significantly associated with patient experience measures. CONCLUSIONS: A negative association exists between CMS HCC risk scores and patient experience measures. To avoid unintended consequences, patient experience measures need further risk adjustment under the CMS 5-star patient survey rating system and the Home Health Value-Based Purchasing pilot program.


Asunto(s)
/organización & administración , Agencias de Atención a Domicilio/organización & administración , Satisfacción del Paciente , Calidad de la Atención de Salud/normas , Ajuste de Riesgo/normas , /normas , Comunicación , Estudios Transversales , Accesibilidad a los Servicios de Salud , Agencias de Atención a Domicilio/normas , Humanos , Educación del Paciente como Asunto/normas , Profesionalismo/normas , Estados Unidos
10.
Am J Manag Care ; 24(5): e150-e156, 2018 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-29851446

RESUMEN

OBJECTIVES: To understand the factors that potentially account for differences in 30-day readmission ratios for pneumonia, heart failure, and acute myocardial infarction (AMI) among hospitals in the Mississippi Delta region (Delta region), in Delta states excluding the hospitals in the Delta region (Delta state), and in the rest of the nation (other). STUDY DESIGN: A longitudinal study design from 2013 to 2016. METHODS: The dependent variables were 30-day readmission ratios for AMI, heart failure, and pneumonia. The key independent variables were 2 hospital categories (Delta region and Delta state), year dummies for 2014-2016, and the interactions among hospital categories and year dummies. We conducted 2 analyses for each study condition by estimating models with and without controls for hospital and community characteristics. RESULTS: The coefficients for the interactions among year dummies and Delta region and Delta state hospitals were negative, indicating that Delta region and Delta state hospitals had higher reductions in readmissions than did other hospitals. After controlling for hospital and community characteristics, the disparities in readmissions for pneumonia and AMI in 2013 between Delta region and other hospitals were weakened (P >.05). Major teaching hospitals and percentage of black population were positively associated with readmissions for all study conditions (P values ranged from <.05 to <.001). CONCLUSIONS: Disparities in 30-day readmissions for the study conditions among Delta region, Delta state, and other hospitals were reduced under the Hospital Readmissions Reduction Program (HRRP). However, community factors that are not currently used for adjustment in HRRP were associated with readmission ratios. Revisions of HRRP should consider including community characteristics in risk adjustment models.


Asunto(s)
Insuficiencia Cardíaca/epidemiología , Infarto del Miocardio/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Neumonía/epidemiología , Adulto , Anciano , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Mississippi/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiología
11.
Public Health Rep ; 133(3): 294-302, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29620480

RESUMEN

OBJECTIVES: The high concentration of smokers among subgroups targeted by the Affordable Care Act and the historically worse health and lower access to health care among smokers warrants an evaluation of how Medicaid expansion affects smokers. We evaluated the impact of Medicaid expansion on smoking behavior, access to health care, and health of low-income adults, and we compared outcomes of all low-income people with outcomes of low-income current smokers by states' Medicaid expansion status. METHODS: We obtained data from the Behavioral Risk Factor Surveillance System (2011-2016) for low-income adults aged 18-64. We estimated multivariable linear ordinary least squares probability models using a quasi-experimental difference-in-difference approach to compare smoking behavior, access to health care, and health between people in expansion states and nonexpansion states and, specifically, on low-income adults and the subgroup of low-income current smokers. RESULTS: Compared with low-income smokers in nonexpansion states, low-income smokers in expansion states were 7.6 percentage points (95% confidence interval [CI], 5.7-9.6; P < .001) more likely to have health insurance, 3.2 percentage points (95% CI, 1.3-5.2; P = .001) more likely to report good or better health, and 2.0 percentage points (95% CI, -3.9 to -0.1; P = .044) less likely to have cost-related barriers to care. Health and insurance gains among current smokers in expansion states were larger relative to health gains (1.6 percentage points; 95% CI, 0.5-2.7; P = .003) and insurance gains (4.6 percentage points; 95% CI, 3.5-5.8; P < .001) of all low-income adults in these states. CONCLUSIONS: Greater improvements among low-income smokers in Medicaid expansion states compared with nonexpansion states could influence future smoking behaviors and warrant longer-term monitoring. Additionally, health and insurance gains among low-income smokers in expansion states suggest the potential for Medicaid expansion to improve health among smokers compared with nonsmokers.


Asunto(s)
Estado de Salud , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Fumadores/estadística & datos numéricos , Adolescente , Adulto , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Pobreza , Estados Unidos , Adulto Joven
12.
Am J Surg ; 215(6): 1004-1010, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29555083

RESUMEN

Precision public health requires research that supports innovative systems and health delivery approaches, programs, and policies that are part of this vision. This study estimated the effects of health insurance mandate (HiM) variations and the effects of physician utilization on moderating colorectal cancer (CRC) screening rates. A time-series analysis using a difference-in-difference-in-differences (DDD) approach was conducted on CRC screenings (1997-2014) using a multivariate logistic framework. Key variables of interest were HiM, CRC screening status, and physician utilization. The adjusted average marginal effects from the DDD model indicate that physician utilization increased the probability of being "up-to-date" vs. non-compliance by 9.9% points (p = 0.007), suggesting that an estimated 8.85 million additional age-eligible persons would receive a CRC screening with HiM and routine physician visits. Routine physician visits and mandates that lower out-of-pocket expenses constitute an effective approach to increasing CRC screenings for persons ready to take advantage of such policies.


Asunto(s)
Neoplasias Colorrectales/epidemiología , Detección Precóz del Cáncer , Cobertura del Seguro/legislación & jurisprudencia , Programas Obligatorios/legislación & jurisprudencia , Tamizaje Masivo/métodos , Médicos/legislación & jurisprudencia , Anciano , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/economía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Morbilidad/tendencias , Estudios Retrospectivos , Factores Socioeconómicos , Encuestas y Cuestionarios , Estados Unidos/epidemiología
13.
Psychiatr Serv ; 69(2): 186-194, 2018 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-29032701

RESUMEN

OBJECTIVE: This study examined services used by young children with autism spectrum disorder (ASD) and factors associated with use. METHODS: A retrospective observational study was conducted with baseline data for toddlers (under age three) and preschoolers (three to less than six years) with ASD enrolled in the Autism Speaks Autism Treatment Network registry from 2008 to 2013 (N=2,804). Parents' reports at enrollment of services received by children were documented. Factors associated with service use and with hours per week of services used were identified by multiple regression analyses. RESULTS: At baseline, 79% of children had received at least one service; 28% had received behavioral services. In the sample, less than 30% of children who received at least one service spent more than ten hours per week in any service use. Children who received services were more likely to be of white race and to have had an ASD diagnosis prior to registry enrollment. Age, previous ASD diagnosis, maternal education, and child's IQ were significantly associated with the use of behavioral services; IQ was negatively associated with use. A consistent trend toward greater use of behavioral services was found over the study period. Factors associated with hours of any services used per week included age, gender, race, maternal education, and clinical characteristics. The predicted average weekly service hours for children with ASD across registry sites ranged from 3.1±1.0 to 9.5±2.1. CONCLUSIONS: Service use varied according to child, family, and system characteristics. More efforts should be focused on early intervention and on children with ASD who have low socioeconomic status and cognitive disability.


Asunto(s)
Trastorno del Espectro Autista/epidemiología , Aceptación de la Atención de Salud/estadística & datos numéricos , Trastorno del Espectro Autista/terapia , Terapia Conductista , Preescolar , Femenino , Humanos , Modelos Lineales , Masculino , Prevalencia , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos , Clase Social , Estados Unidos/epidemiología
14.
Med Care ; 55(11): 924-930, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-29028756

RESUMEN

BACKGROUND: Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. OBJECTIVE: To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). RESEARCH DESIGN: We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). RESULTS: The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. CONCLUSIONS: The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.


Asunto(s)
Economía Hospitalaria/organización & administración , Programas de Gobierno/estadística & datos numéricos , Readmisión del Paciente/economía , Evaluación de Programas y Proyectos de Salud/economía , Compra Basada en Calidad/economía , Programas de Gobierno/métodos , Humanos , Mississippi , Estados Unidos
15.
JMIR Mhealth Uhealth ; 5(9): e133, 2017 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-28903892

RESUMEN

BACKGROUND: Two-thirds of pregnant women exceed gestational weight gain (GWG) recommendations. Because excess GWG is associated with adverse outcomes for mother and child, development of scalable and cost-effective approaches to deliver intensive lifestyle programs during pregnancy is urgent. OBJECTIVE: The aim of this study was to decrease the proportion of women who exceed the Institute of Medicine (IOM) 2009 GWG guidelines. METHODS: In a parallel-arm randomized controlled trial, 54 pregnant women (age 18-40 years) who were overweight (n=25) or obese (n=29) were enrolled to test whether an intensive lifestyle intervention (called SmartMoms) decreased the proportion of women with excess GWG, defined as exceeding the 2009 IOM guidelines, compared to no intervention (usual care group). The SmartMoms intervention was delivered through mobile phone (remote group) or in a traditional in-person, clinic-based setting (in-person group), and included a personalized dietary intake prescription, self-monitoring weight against a personalized weight graph, activity tracking with a pedometer, receipt of health information, and continuous personalized feedback from counselors. RESULTS: A significantly smaller proportion of women exceeded the IOM 2009 GWG guidelines in the SmartMoms intervention groups (in-person: 56%, 10/18; remote: 58%, 11/19) compared to usual care (85%, 11/13; P=.02). The remote intervention was a lower cost to participants (mean US $97, SD $6 vs mean US $347, SD $40 per participant; P<.001) and clinics (US $215 vs US $419 per participant) and with increased intervention adherence (76.5% vs 60.8%; P=.049). CONCLUSIONS: An intensive lifestyle intervention for GWG can be effectively delivered via a mobile phone, which is both cost-effective and scalable. TRIAL REGISTRATION: Clinicaltrials.gov NCT01610752; https://clinicaltrials.gov/ct2/show/NCT01610752 (Archived by WebCite at http://www.webcitation.org/6sarNB4iW).

16.
Matern Child Health J ; 21(2): 351-366, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-27449784

RESUMEN

Objective The study investigated whether state mandates for private insurers to provide services for children with autism influence racial disparities in outcomes. Methods The study used 2005/2006 and 2009/2010 waves of the National Survey of Children with Special Health Care Needs. Children with a current diagnosis of autism were included in the sample. Children residing in 14 states and the District of Columbia that were not covered by the mandate in the 2005/2006 survey, but were covered in the 2009/2010 survey, served as the mandate group. Children residing in 32 states that were not covered by a mandate in either wave served as the comparison group. Outcome measures assessed included care quality, family economics, and child health. A difference-in-difference-in-differences (DDD) approach was used to assess the impact of the mandates on racial disparities in outcomes. Results Non-white children had less access to family-centered care compared to white children in both waves of data, but this difference was not apparent across mandate and comparison states as only the comparison states had significant differences. Parents of non-white children reported paying less in annual out-of-pocket expenses compared to parents of white children across waves and groups. DDD estimates did not provide evidence that the mandates had statistically significant effects on improving or worsening racial disparities for any outcome measure. Conclusions This study did not find evidence that state mandates on private insurers affected racial disparities in outcomes for children with autism.


Asunto(s)
Trastorno Autístico/economía , Disparidades en Atención de Salud/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Programas Obligatorios/estadística & datos numéricos , Evaluación del Resultado de la Atención al Paciente , Adolescente , Trastorno Autístico/epidemiología , Distribución de Chi-Cuadrado , Niño , Preescolar , Grupos de Población Continentales/estadística & datos numéricos , Niños con Discapacidad/estadística & datos numéricos , Escolaridad , Grupo de Ascendencia Continental Europea/etnología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Disparidades en Atención de Salud/etnología , Humanos , Renta/estadística & datos numéricos , Lactante , Masculino , Pobreza/estadística & datos numéricos , Racismo/etnología , Racismo/estadística & datos numéricos
17.
Clin Pediatr (Phila) ; 56(6): 555-563, 2017 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27798388

RESUMEN

OBJECTIVE: Given poor use of recall in primary care practices, we compared outsourced versus office-based recall systems. STUDY DESIGN: From 2011 to 2013, we enrolled 87 individual Arkansas providers in distinct practices treating their own patients <24 months of age which were randomized to usual care (A), office-based (B), or outsourced (C) recall groups. RESULTS: At the end of study, recall activity was 19.4%, 55.0%, and 92.6% for Groups A, B, and C, respectively (B and C vs A: P < .001). Only 68 Group B patients were identified as needing immunizations versus 826 in Group C. The majority of successful contacts were made through mobile phone (41.3%) or text message (32.6%). The total cost per practice per week was significantly lower for Group C versus Group B ($39.50 and $53.00, respectively; P = .004). CONCLUSIONS: With limited electronic health record use, an outsourced recall system is more sustainable and less costly than an office-based system.


Asunto(s)
Esquemas de Inmunización , Inmunización/estadística & datos numéricos , Pautas de la Práctica en Medicina/organización & administración , Atención Primaria de Salud/organización & administración , Sistemas Recordatorios/estadística & datos numéricos , Arkansas , Servicios de Salud del Niño/organización & administración , Investigación sobre la Eficacia Comparativa , Femenino , Humanos , Lactante , Recién Nacido , Masculino
18.
Am J Manag Care ; 22(1): e38-44, 2016 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-26799203

RESUMEN

OBJECTIVES: To explore the feasibility of applying value-based insurance designs (V-BIDs) to the treatment of mental health disorders and address any additional challenges posed. STUDY DESIGN: Literature review. METHODS: This study consisted of 3 steps. First, we reviewed the historical literature on V-BIDs and challenges revealed by various programs. Second, we reviewed the literature on the cost, scope, and various treatment options for mental health disorders. Third, we analyzed potential challenges in applying V-BIDs to mental health disorders. RESULTS: Many challenges exist in applying V-BID to the management and treatment of physical and mental health disorders, such as getting buy-in from insurance companies and from large employers, and adherence issues for those with diminished capabilities to comprehend program benefits and those lacking family support. Additional challenges specific to mental health disorders include: a) privacy (ie, sensitivity issues) in implementing the program in certain settings; and b) sociodemographic variables, along with perceptions of mental disorder severity and need that currently affect the take-up of mental health services. CONCLUSIONS: Research projects focused on applying V-BID to mental health disorders that address these challenges and demonstrate cost savings will be needed (ie, comparative effectiveness research studies), along with additional information on changes in disability-adjusted life-years, and on-demand responses across different mental health services, populations, and care settings.


Asunto(s)
Servicios de Salud Mental/economía , Seguro de Salud Basado en Valor , Análisis Costo-Beneficio , Humanos , Años de Vida Ajustados por Calidad de Vida
19.
Pharmacoeconomics ; 34(2): 127-38, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26446859

RESUMEN

The National Database for Autism Research (NDAR) is a US National Institutes of Health (NIH)-funded research data repository created by integrating heterogeneous datasets through data sharing agreements between autism researchers and the NIH. To date, NDAR is considered the largest neuroscience and genomic data repository for autism research. In addition to biomedical data, NDAR contains a large collection of clinical and behavioral assessments and health outcomes from novel interventions. Importantly, NDAR has a global unique patient identifier that can be linked to aggregated individual-level data for hypothesis generation and testing, and for replicating research findings. As such, NDAR promotes collaboration and maximizes public investment in the original data collection. As screening and diagnostic technologies as well as interventions for children with autism are expensive, health services research (HSR) and health technology assessment (HTA) are needed to generate more evidence to facilitate implementation when warranted. This article describes NDAR and explains its value to health services researchers and decision scientists interested in autism and other mental health conditions. We provide a description of the scope and structure of NDAR and illustrate how data are likely to grow over time and become available for HSR and HTA.


Asunto(s)
Trastorno Autístico , Bases de Datos Factuales , Investigación sobre Servicios de Salud/organización & administración , Evaluación de la Tecnología Biomédica/métodos , Trastorno Autístico/diagnóstico , Trastorno Autístico/terapia , Niño , Conducta Cooperativa , Recolección de Datos/métodos , Humanos , Difusión de la Información , Tamizaje Masivo/métodos , Estados Unidos
20.
J Autism Dev Disord ; 45(11): 3613-23, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26126749

RESUMEN

Sleep problems in children with autism spectrum disorders (ASD) are under-recognized and under-treated. Identifying treatment value accounting for health effects on family members (spillovers) could improve the perceived cost-effectiveness of interventions to improve child sleep habits. A prospective cohort study (N = 224) was conducted with registry and postal survey data completed by the primary caregiver. We calculated quality of life outcomes for the child and the primary caregiver associated with treatments to improve sleep in the child based on prior clinical trials. Predicted treatment effects for melatonin and behavioral interventions were similar in magnitude for the child and for the caregiver. Accounting for caregiver spillover effects associated with treatments for the child with ASD increases treatment benefits and improves cost-effectiveness profiles.


Asunto(s)
Trastorno Autístico/tratamiento farmacológico , Trastorno Autístico/terapia , Terapia Conductista , Cuidadores/psicología , Melatonina/uso terapéutico , Sistema de Registros , Trastornos del Sueño-Vigilia/terapia , Adulto , Trastorno Autístico/complicaciones , Niño , Costo de Enfermedad , Análisis Costo-Beneficio , Estudios Transversales , Femenino , Humanos , Masculino , Estudios Prospectivos , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/tratamiento farmacológico , Encuestas y Cuestionarios , Adulto Joven
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