Outcomes In Two Massachusetts Hospital Systems Give Reason For Optimism About Communication-And-Resolution Programs [Original Article]
Through communication-and-resolution programs, hospitals and liability insurers communicate with patients when adverse events occur; investigate and explain what happened; and, where appropriate, apologize and proactively offer compensation. Using data recorded by program staff members and from surveys of involved clinicians, we examined case outcomes of a program used by two academic medical centers and two of their community hospitals in Massachusetts in the period 2013–15. The hospitals demonstrated good adherence to the program protocol. Ninety-one percent of the program events did not meet compensation eligibili...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Mello, M. M., Kachalia, A., Roche, S., Niel, M. V., Buchsbaum, L., Dodson, S., Folcarelli, P., Benjamin, E. M., Sands, K. E. Tags: Original Article Source Type: research
Despite Increased Insurance Coverage, Nonwhite Sexual Minorities Still Experience Disparities In Access To Care [Original Article]
Previous studies suggest that members of sexual minority groups have poorer access to health services than heterosexuals. However, few studies have examined how sexual orientation interacts with gender and race to affect health care experience. Moreover, little is known about the role in health care disparities played by economic strains such as unemployment and poverty, which may result from prejudice and discrimination based on sexual orientation. Using data for 2013–15 from the National Health Interview Survey, we found that most members of sexual minority groups no longer have higher uninsurance rates than hetero...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Hsieh, N., Ruther, M. Tags: Original Article Source Type: research
Health Care In The Suburbs: An Analysis Of Suburban Poverty And Health Care Access [Original Article]
The objectives of this study were to compare patterns of insurance coverage and health care access in suburban, urban, and rural areas using national survey data from 2005 to 2015 and to compare outcomes by geography before and after the Affordable Care Act took effect. We found that nearly 40 percent of the uninsured population lived in suburban areas. Though unadjusted rates of health care access were better in suburban areas, compared to urban and rural communities, this advantage was greatly reduced after income and other demographics are accounted for. Overall, a substantial portion of the US population residing ...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Schnake-Mahl, A. S., Sommers, B. D. Tags: Original Article Source Type: research
Early Medicaid Expansion Associated With Reduced Payday Borrowing In California [Original Article]
We examined the impact of California’s early Medicaid expansion under the Affordable Care Act on the use of payday loans, a form of high-interest borrowing used by low- and middle-income Americans. Using a data set for the period 2009–13 (roughly twenty-four months before and twenty-four months after the 2011–12 Medicaid expansion) that covered the universe of payday loans from five large payday lenders with locations around the United States, we used a difference-in-differences research design to assess the effect of the expansion on payday borrowing, comparing trends in early-expansion counties in Calif...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Allen, H., Swanson, A., Wang, J., Gross, T. Tags: Original Article Source Type: research
High-Deductible Health Plans Reduce Health Care Cost And Utilization, Including Use Of Needed Preventive Services [Original Article]
Enrollment in high-deductible health plans (HDHPs) has greatly increased in recent years. Policy makers and other stakeholders need the best available evidence about how these plans may affect health care cost and utilization, but the literature has not been comprehensively synthesized. We performed a systematic review of methodologically rigorous studies that examined the impact of HDHPs on health care utilization and costs. The plans were associated with a significant reduction in preventive care in seven of twelve studies and a significant reduction in office visits in six of eleven studies—which in turn led to a ...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Agarwal, R., Mazurenko, O., Menachemi, N. Tags: Original Article Source Type: research
Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder [Original Article]
This study examined whether implementing autism mandates altered service use or spending among commercially insured children with ASD. We compared children age twenty-one or younger who were eligible for mandates to children not subject to mandates using 2008–12 claims data from three national insurers. Increases in service use and spending attributable to state mandates were detected for all outcomes. Mandates were associated with a 3.4-percentage-point increase in monthly use and a $77 increase in monthly spending on ASD-specific services. Effects were larger for younger children and increased with the number of ye...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Barry, C. L., Epstein, A. J., Marcus, S. C., Kennedy-Hendricks, A., Candon, M. K., Xie, M., Mandell, D. S. Tags: Original Article Source Type: research
Opioid Abuse And Poisoning: Trends In Inpatient And Emergency Department Discharges [DataWatch]
Addressing the opioid epidemic is a national priority. We analyzed national trends in inpatient and emergency department (ED) discharges for opioid abuse, dependence, and poisoning using Healthcare Cost and Utilization Project data. Inpatient and ED discharge rates increased overall across the study period, but a decline was observed for prescription opioid–related discharges beginning in 2010, while a sharp increase in heroin-related discharges began in 2008. (Source: Health Affairs)
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Tedesco, D., Asch, S. M., Curtin, C., Hah, J., McDonald, K. M., Fantini, M. P., Hernandez-Boussard, T. Tags: Mental Health/Substance Abuse, Pharmaceuticals DataWatch Source Type: research
Prevalence, Treatment, And Unmet Treatment Needs Of US Adults With Mental Health And Substance Use Disorders [Original Article]
We examined prevalence, treatment patterns, trends, and correlates of mental health and substance use treatments among adults with co-occurring disorders. Our data were from the 325,800 adults who participated in the National Survey on Drug Use and Health in the period 2008–14. Approximately 3.3 percent of the US adult population, or 7.7 million adults, had co-occurring disorders during the twelve months before the survey interview. Among them, 52.5 percent received neither mental health care nor substance use treatment in the prior year. The 9.1 percent who received both types of care tended to h...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Han, B., Compton, W. M., Blanco, C., Colpe, L. J. Tags: Original Article Source Type: research
Emergency Department Visits For Firearm-Related Injuries In The United States, 2006-14 [Original Article]
Firearm-related deaths are the third leading cause of injury-related deaths in the United States. Yet limited data exist on contemporary epidemiological trends and risk factors for firearm-related injuries. Using data from the Nationwide Emergency Department Sample, we report epidemiological trends and quantify the clinical and financial burden associated with emergency department (ED) visits for firearm-related injuries. We identified 150,930 patients—representing a weighted total of 704,916 patients nationally—who presented alive to the ED in the period 2006–14 with firearm-related injuries. Such injuri...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Gani, F., Sakran, J. V., Canner, J. K. Tags: Original Article Source Type: research
Persistent Frequent Emergency Department Use: Core Group Exhibits Extreme Levels Of Use For More Than A Decade [Original Article]
Many frequent emergency department (ED) users do not sustain high use over time, which makes it difficult to create targeted interventions to address their health needs. We performed a retrospective analysis of nonelderly adult frequent ED users in California to measure the persistence of frequent ED use in the period 2005–15, describe characteristics of persistent and nonpersistent frequent users, and identify predictors of persistent frequent use. Of the frequent ED users in 2005, 30.5 percent remained frequent users in 2006. A small but nontrivial population (16.5 percent, 5.7 percent, and 1.9 ...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Kanzaria, H. K., Niedzwiecki, M. J., Montoy, J. C., Raven, M. C., Hsia, R. Y. Tags: Original Article Source Type: research
Freestanding Emergency Departments Preferentially Locate In Areas With Higher Household Income [Original Article]
Freestanding emergency departments (EDs) are a relatively novel phenomenon, and the epicenter of this movement is in Texas. Limited evidence exists about the communities in which freestanding EDs locate or the possible reasons behind location choice. We estimated logistic regressions to determine whether freestanding EDs in 2016 were more likely to be in areas of high demand or in those that could yield high profits. When we compared Public Use Microdata Areas that contained freestanding EDs and those that did not, we found that areas with such EDs had significantly higher household incomes. This finding was driven by the ...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Dark, C., Xu, Y., Ho, V. Tags: Original Article Source Type: research
Coordination Program Reduced Acute Care Use And Increased Primary Care Visits Among Frequent Emergency Care Users [Original Article]
Many high utilizers of the emergency department (ED) have public insurance, especially through Medicaid. We evaluated how participation in Bridges to Care (B2C)—an ED-initiated, multidisciplinary, community-based program—affected subsequent ED use, hospital admissions, and primary care use among publicly insured or Medicaid-eligible high ED utilizers. During the six months after the B2C intervention was completed, participants had significantly fewer ED visits (a reduction of 27.9 percent) and significantly more primary care visits (an increase of 114.0 percent), compared to patients in the control gr...
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Capp, R., Misky, G. J., Lindrooth, R. C., Honigman, B., Logan, H., Hardy, R., Nguyen, D. Q., Wiler, J. L. Tags: Original Article Source Type: research
Low-Cost, High-Volume Health Services Contribute The Most To Unnecessary Health Spending [DataWatch]
An analysis of data for 2014 about forty-four low-value health services in the Virginia All Payer Claims Database revealed more than $586 million in unnecessary costs. Among these low-value services, those that were low and very low cost ($538 or less per service) were delivered far more frequently than services that were high and very high cost ($539 or more). The combined costs of the former group were nearly twice those of the latter (65 percent versus 35 percent). (Source: Health Affairs)
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Mafi, J. N., Russell, K., Bortz, B. A., Dachary, M., Hazel, W. A., Fendrick, A. M. Tags: DataWatch Source Type: research
Breakthrough Cancer Treatments Raise Difficult Questions [Entry Point]
The approval of a first-of-its kind cancer therapy creates new challenges related to safety, access, and costs. (Source: Health Affairs)
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Authors: Maschke, K. J., Gusmano, M. K., Solomon, M. Z. Tags: Entry Point Source Type: research
Aging and Health [DataGraphic]
As the US population ages, researchers have been testing various policies and models of care aimed at improving the quality of care for elderly patients, including those living at home and in nursing centers. This DataGraphic presents results of six studies that tested the degree to which one or more innovations achieved such goals as enabling people to age at home, avoid hospitalizations, and receive better cancer care. Health Affairs thanks the John A. Hartford Foundation for its support of the Aging and Health series, which focuses on improving care for older adults. (Source: Health Affairs)
Source: Health Affairs - October 2, 2017 Category: International Medicine & Public Health Tags: DataGraphic Source Type: research
