Jonathan Skinner

..Less is known about differences in health outcomes. This report compares risk-adjusted mortality after acute myocardial infarction (AMI) between US hospitals with high and low fractions of elderly black AMI patients...

..Instead, end-of-life care makes Miami truly exceptional: Patients in their last six months of life see more physicians and spend more time in intensive care than is the case virtually anywhere else in the world...

..Improving the health of minority patients who have diabetes depends in part on improving quality and reducing disparities in ambulatory care. It has been difficult to measure these components at the level of actionable units...

..Current methods of risk adjustment rely on diagnoses recorded in clinical and administrative records. Differences among providers in diagnostic practices could lead to bias...

..We studied whether high-income Medicare recipients are more likely to have a knee arthroplasty and less likely to suffer from knee osteoarthritis...

..However, the large numbers of patients who crossed over between assigned groups precluded any conclusions about the comparative effectiveness of operative therapy vs usual care...

..However, we find that patients' preferences for seeking primary and specialty medical care do not play a significant role in explaining regional variation in health care use...

....

..This paper recommends a strategy for achieving this goal...

..The common thread linking greater care intensity with lower quality and less favorable patient experiences may be poorly coordinated care...

..Because diagnosis is typically thought of as purely a patient attribute, it is considered a critical factor in risk-adjustment policies designed to reward efficient and high-quality care...

..To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness...

..We suggest that our proposal be tested in a major demonstration project..

..Differences in end-of-life care are driven more by residence than by race. Policies should focus on getting the rates right, rather than solely on racial differences...

..Lumbar diskectomy is the most common surgical procedure performed for back and leg symptoms in US patients, but the efficacy of the procedure relative to nonoperative care remains controversial...

..The findings suggest that utilization-not local price differences-drives Medicare regional payment variations, along with special payments for medical education and care for the poor...

..We simulate the potential expenditure impact and show that significant Medicare savings are possible...

....

....

..Cooper may believe that this result challenges three decades of research by the Dartmouth group. Instead, it supports the group's view that improved efficiency-and not more doctors and hospital beds-is central to improving quality...

..There are large variations in the use of knee arthroplasty among Medicare enrollees according to race or ethnic group and sex. Are racial and ethnic disparities more pronounced in some regions than in others, and if so, why?..

..Such inefficiency exposes patients to unnecessary risk, drives costs up unnecessarily, and highlights the large potential gains arising from improved care coordination for dual eligibles...

..Upcoding appears to reflect both risk-taking by administrators and a closer alignment between the goals of the administration and the behavior of the clinical staff...

..The SPORT (Spine Patient Outcomes Research Trial) reported favorable surgery outcomes over 2 years among patients with stenosis with and without degenerative spondylolisthesis, but the economic value of these surgeries is uncertain...

..Our study focused on the effect of stent type on population-based interventional outcomes...

..Wide variations in Medicare expenditures exist across regions, but little is known about whether beneficiaries residing in low-expenditure regions perceive receiving lower-quality care than those in high-expenditure regions...

..We sought to test whether variations across regions in end-of-life (EOL) treatment intensity are associated with regional differences in patient preferences for EOL care...

..Regions experiencing the largest spending gains were not those realizing the greatest improvements in survival. Factors yielding the greatest benefits to health were not the factors that drove up costs, and vice versa...

..We suggest that our proposal be tested in a major demonstration project...

..For these reasons, the primary argument for volume-based referral strategies should be improving quality, not reducing costs...

..S. health care system: 30% of health care spending is wasted, and quality of care is seriously lacking. We also explore several approaches to improving quality and reducing unwarranted variations in expenditures. ..