Arnold Epstein

..Yet variation in readmission rates may more closely reflect variation in the underlying hospitalization rates than differences in the quality of care during and after discharge...

..Most of all, we need to find better ways to use quality reporting to empower purchasers and consumers and improve quality of care...

..However, few studies have examined whether these differences reflect problems in quality of care...

..Despite abundant evidence of racial disparities in the use of surgical procedures, it is uncertain whether these disparities reflect racial differences in clinical appropriateness or overuse or underuse of inappropriate care...

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..Although increasing numbers of states collect data on satisfaction, access, and quality of care, few states have been able to document improved performance in the health plans they oversee...

..Little is known about how the characteristics of adverse events (AEs) affect the likelihood of disclosure or how the disclosure of an AE relates to patients' perception of quality of care...

..Racial differences in preferences for renal transplantation among men may be associated with their levels of physical activity...

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..However, the differences between accredited and nonaccredited health plans and the impact of accreditation on plan enrollment are not well understood...

..As the design of Medicare with pay for performance moves forward, it will be important to leverage the early experience of pay for performance in the commercial market...

..CONCLUSIONS: For the decade of the 1990s, we found no evidence, either nationally or locally, that efforts to eliminate racial disparities in the use of high-cost surgical procedures were successful...

..Thirteen percent of medical groups and 19 percent of IPAs provided bonuses or withholds based on utilization or cost performance, which averaged 10 percent of base compensation...

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..Data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey provide a portrait of patients' experiences in U.S. hospitals...

..The relationship between high HQA performance and lower risk-adjusted mortality is an important validation for this national hospital quality rating program...

..We know little about how U.S. hospitals perform on the current discharge metrics, the factors that underlie better performance, and whether better performance is related to lower readmission rates...

..Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown...

..Nevertheless, performance was not associated with a subsequent change in market share. Surgeons with the highest mortality rates were much more likely than other surgeons to retire or leave practice after the release of each report card...

..A better understanding of physicians' views about racial differences in access to transplantation may help reduce disparities in care...

..For-profit health plans now enroll the majority of Medicare beneficiaries who select managed care. Prior research has produced conflicting results about whether for-profit health plans provide lower quality of care...

..The number of long-term survivors after a cancer diagnosis is increasing, yet relatively few studies have addressed survivors' reported symptoms beyond the initial year after diagnosis...

..In contrast to the commercially insured population, the proportion of Medicaid beneficiaries enrolling in health maintenance organizations continues to increase...

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..Our finding that care for Hispanics is concentrated among a small number of hospitals provides an opportunity for targeted efforts to improve care for this group of Americans...

..They provided modestly worse care for acute myocardial infarction and congestive heart failure but had comparable rates of risk-adjusted mortality. We found no evidence that low-cost providers provide better care...

..Whether this program helps identify high-quality hospitals is unknown. A study was conducted to determine whether hospitals that report patient safety practice activities have better quality of care or clinical outcomes...

..We assessed whether beneficiaries in MMC plans were more likely than those in traditional FFS insurance to receive colorectal cancer (CRC) screening and whether type of insurance was associated with use of specific screening strategies...

..To examine the current state of quality monitoring and management activities of US health plans...

..Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care...

..The Hospital Quality Alliance (HQA) is the first initiative that routinely reports data on hospitals' performance nationally. Heretofore, such data have been unavailable...

..Reporting states tended to emphasize utilization results over quality-measure results. Despite growing enrollment, PCCM programs appear less likely to use the quality-oversight strategies employed by Medicaid health plans...

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..Until recently, data to address this question have been limited...

..Many employers and health plans have adopted incentive-based formularies in an attempt to control prescription-drug costs...

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..We investigated whether physician adherence to guidelines for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) varied by source, development methods, or the extent of their evidence-base...

..Substantial racial disparities in the use of some health services exist; however, much less is known about racial disparities in the quality of care...

..Guidelines issued in 1997 by the Food and Drug Administration (FDA) regarding advertising to consumers through electronic media are considered by some to be responsible for unleashing a flood of direct-to-consumer advertising...

..Many employers and health plans have adopted 3-tier formularies in an attempt to control costs for these and other drugs...

..Aggregate savings estimates vary widely, based on uncertainty in discounts and program participation rates...

..Hospitals routinely survey patients about the quality of care they receive, but little is known about whether patient interviews can detect adverse events that medical record reviews do not...

..We investigated whether these differences reflect variations in the rate or qualitative aspects of the provider's discussion of reconstruction as an option...

..The large differences in board activities between high-performing and low-performing hospitals we found suggest that governing boards may be an important target for intervention for policymakers hoping to improve care in U.S. hospitals...

..Yet our results indicate that policy makers should prepare to handle a broad range of contingencies and uncertainty in Medicaid expansion under health reform...

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..However, much additional work remains necessary before the project can supply policymakers and researchers with ongoing, comprehensive, and reliable data on the quality of care in industrialized countries...

..We find that the VHA National Formulary was effective at shifting prescribing behavior toward the selected drugs, achieving sizable price reductions from manufacturers, and greatly decreasing drug spending...

..The association between the organizational structure of physician groups and health care quality has never been evaluated empirically...

..Among breast cancer patients, tamoxifen use is associated with reduced risk of disease relapse and death, but it is often difficult for women to sustain therapy during the 5 years required to obtain maximum benefit...

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..The Institute of Medicine has recommended establishing mandatory error reporting systems for hospitals and other health settings...

..4) To examine the association between the intensity of VBP activities and changes in quality performance as measured by HEDIS and CAHPS. ..