Medical Care最新文献

Background: Critics argue that Medicare's Quality of Patient Care home health star ratings are inaccurate. Valid ratings are essential to help patients find high-quality care.

Objective: The aim of this study was to determine whether using the highest-rated home health agency available in a ZIP code improves outcomes.

Research design: A retrospective study of 1,870,080 Medicare fee-for-service beneficiaries using home health care from July 2015 through July 2016 in the United States. An instrumental variables approach is used to address the endogeneity of agency choice, where the instrument is the differential proximity of the patient to the closest highest-rated and closest lower-rated agency.

Outcomes: Days independently at home; health care setting-specific days and death; hospitalization, emergency department use, and institutionalization risk.

Results: Treatment by the highest-rated agencies available decreased risks (in percentage points) of hospitalization (-3.2; 95% CI, -4.1 to -2.3), emergency department use (-2.2; 95% CI, -3.2 to -1.1), and institutionalization (-0.9; 95% CI, -1.3 to -0.5) during the initial episode, and increased days independently at home by 2.6% or 3.75 (95% CI, 2.20-5.29) days in the 180 days after the end of the initial episode. Treatment effects were more pronounced for agencies that were above-average (6.51 d; 95% CI, 4.15-8.87), had ≥1 more star than the next-best agency (7.80 d; 95% CI, 4.13-11.47), and nonrural residents (4.57 d; 95% CI, 2.75-6.40). Effects were positive for both postacute (3.40; 95% CI, 1.80-5.00) and community-entry (5.60; 95% CI, 2.30-8.89) patients.

Conclusions: Medicare's Quality of Patient Care star rating correlates with reduced short-term hospitalizations and emergency department use and increased days independently at home in the longer term.

Background: Primary care providers (PCP) differ in their ability to address the needs and reduce use of costly services among complex Medicaid beneficiaries. Among PCPs, Health Resources and Services Administration (HRSA)-funded health centers (HCs) are shown to provide high-value care.

Objective: We compared health care utilization of complex Medicaid managed care beneficiaries whose PCPs were HCs versus 3 other groups.

Research design: Cross-sectional study using propensity score matching comparing health care use by provider type, controlling for demographics, health status, and other covariates.

Subjects: California Medicaid administrative data for complex adult managed care beneficiaries with at least 1 primary care visit in 2018.

Measures: Primary and specialty care evaluation & management visits and services; emergency department (ED) visits; and hospitalizations. PCPs included HCs, clinics not funded by HRSA, solo, and group practice providers.

Results: HRSA-funded HCs had lower predicted rates of specialty evaluation & management and other services than all others; lower predicted probability of any ED visits than clinics not funded by HRSA [54% (95% CI: 53%-55%) vs. 56% (95% CI: 55%-57%)] and group practice providers [51% (95% CI: 51%-52%) vs. 52% (95% CI: 52%-53%)]; and lower PP of any hospitalizations than solo [20% (95% CI: 19%-20%) vs. 23% (95% CI: 22%-24%)] and group practice providers [21% (95% CI: 20%-21%) vs. 24% (95% CI: 23%-24%)].

Conclusions: Differences in HC care delivery and practices were associated with lower use of specialty, ED, and hospitalization visits compared with other PCPs for complex Medicaid managed care beneficiaries. Understanding the underlying reasons for these utilization differences may promote better outcomes among these patients.

Background: The COVID-19 pandemic increased telehealth services in federally funded community health centers (CHCs). Yet little is known about common determinants of use among CHC patients.

Objective: We examined the use of telehealth among patient participants at 1 large CHC network providing care to underserved populations at urban and suburban sites in the Midwest.

Methods: We conducted a mixed-methods study utilizing a sequential explanatory design. Participants were English and/or Spanish-speaking adults who attended ≥1 visits for themselves or their child over a 12-month period at any practice location. Research staff conducted a structured phone survey of eligible adults. The results subsequently facilitated purposive sampling of telehealth "users" and "nonusers" for qualitative phone interviews.

Results: The survey participants included 500 adults. Most had access to the resources needed to utilize telehealth, including a smartphone (90.4%) and home internet (83.0%). About half (50.8%) "rarely or never" had problems with internet speed, reliability, or quality. Most (81.1%) were aware of the patient portal and 59.8% had utilized video visits. Participants who were Spanish-speaking and with limited English proficiency faced some of the greatest barriers. Qualitative interview participants included 12 users and 12 nonusers of telehealth. Users found telehealth convenient and efficient, while nonusers lacked awareness about how telehealth services could be beneficial or needed assistance to sign up, join, or use telehealth.

Conclusions: Most participants had the resources and awareness necessary to use telehealth services. Those who use them appreciate the convenience and efficiency. Nevertheless, additional support may be needed to prevent telehealth from exacerbating health inequities.