SHARON LISE TERESA NORMAND

..We compared risk-adjusted sequential probability ratio testing (RA-SPRT) implemented in an automated tool to Massachusetts public reports of 30-day mortality after isolated coronary artery bypass graft surgery...

..Methods are demonstrated using the data from five distinct panels convened as part of the Harvard Q-SPAN-CD study, a nationally-funded project whose goal is to identify a set of cardiovascular-related performance measures...

..To control costs and improve quality, payers are designing new hospital reimbursement policies that link payment to quality. The authors determine the extent to which quality measures discriminate hospitals into tiers in 2 geographic areas...

..These results suggest that current risk-adjustment systems may fail to offset selection incentives in modern capitated health plans...

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..The average spending for all observed treatments was $473 (SE = 478), with a depression-free adjusted price per case of $5,995 (95% confidence interval = $5,959-$6,031)...

..If researchers are interested in comparing clusters, hierarchical models are preferred...

..Because of the magnitude of the benefit and of the number of patients involved, steps should be taken to replicate these findings...

..During 2004 in the United States, although 68% of hospital stays for partial or total hip replacements were for those aged 65 years and older, younger patients will account for 52% by 2030...

..Using logistic regression and hierarchical models, we compared hospital cardiac surgery profiling results based on clinical data with those derived from contemporaneous administrative data...

..Using cost-effectiveness methods to profile hospital "value'' permits the comparison of the benefit of a service relative to the cost using existing societal weights...

..We recommend the new estimators as they are unbiased even when outcomes are not missing at random and they are more efficient than established estimators in the presence of covariate effects under the widest variety of circumstances...

..The purpose of this study was to compare the treatment of schizophrenia for disabled Medicaid beneficiaries who were and were not enrolled in managed care...

..The aims of this study were to examine labor supply effects of interventions for major depressive disorder and to compare these effects with a summary measure of clinical effectiveness...

..Major depressive disorder (MDD) is a prevalent but often undetected and undertreated and thus could potentially benefit from parity implementation...

..Examples of evidence-based guidelines are the PORT recommendations for the treatment of schizophrenia. However, few studies have examined the relationship between adherence to guidelines and patient outcomes in clinical settings...

..The Joint Commission on Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services recently began reporting on quality of care for acute myocardial infarction, congestive heart failure, and pneumonia...

..We illustrate methods using data from a trial to compare the efficacy of two antipsychotics for adults with refractory schizophrenia...

..To examine the impact of incentive formularies on prescription drug spending shifts in formulary compliance, use of generic medications, and mail-order fulfillment in the year after introduction of a new pharmacy benefit strategy...

..Hospitals estimated to have the highest and lowest value according to each method are compared for consistency, and the advantages and disadvantages of each approach are discussed...

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

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..Because a high proportion of U.S. physicians practice in small settings, programs and policies based on physician performance measurement should incorporate features that facilitate the inclusion of these physicians...

..The concept of "risk-adjusted" outcomes is frequently misunderstood, particularly when it is used to justify the direct comparison of performance at 2 specific institutions...

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

..Studies comparing percutaneous coronary intervention (PCI) with drug-eluting and bare-metal coronary stents in acute myocardial infarction have been limited in size and duration...

..To assess the effects of an intervention involving dissemination of treatment recommendations to primary care physicians treating outpatients with acute myocardial infarction or heart failure...

..Medicaid beneficiaries with dual diagnoses are 6-8 times more likely to die of injury, primarily poisoning, than their counterparts treated for medical conditions only...

..Even then, for some uses, physician clinical performance assessment at the individual physician level may be technically impossible to accomplish in a valid and fair way...

..Our principle conclusions are that exact sample size calculations can be substantially different from current approximations, and stochastic optimization provides a convenient method of computation...

..Public Law 102-321 established a block grant for adults with "serious mental illness" (SMI) and required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a method to estimate the prevalence of SMI...

..The authors examined whether certain medical disorders are more prevalent among adults with severe mental illness and whether a comorbid substance use disorder increases prevalence beyond the effect of severe mental illness alone...

..When considering proportion diameter stenosis, the corresponding posterior means are 0.375 (0.020) and 0.427 (0.030). The correlation coefficient of the components of the OPC lies in the range 0.042 to 0.116...

..Based on hedonic regression equations that account for the effects of changing patient mix, we find reductions that range from about -1.66 to -2.13% per year...

..In mental health services research there is little empirical evidence to support speculation about the relationship between costs and quality...

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..The study investigated the determinants of warfarin use in patients with atrial fibrillation (AF)...

..Regulatory agencies should require use of analytic methods that handle the complexity of health status data in addition to usual protocol protections...

..These include the choice of a statistical model and analytical technique, national versus regional reference population, and whether individual surgeon profiling is required...

..The causes of regional variation in underuse do not appear to be related to regional differences in patient or hospital characteristics, and therefore, require further study...

..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...

..Financial practices of most practices are geared towards rewarding productivity, and care management practices and capabilities such as electronic medical records remain underdeveloped...

..In this setting, self-report was better than clinician rating in predicting psychiatric outcome. Differences between the two in relation to other outcomes need to be examined...

..Theoretically, the use of hierarchical models should result in more accurate representation of provider performance...

..Identification of these high-risk zones for acute coronary occlusions will lead to future advances in vulnerable plaque detection technology and potentially locally directed preventive strategies...

..The authors examined associations between Medicaid managed mental health care in Massachusetts and rates of admission to the inpatient forensic mental health service maintained by the state's mental health department...

..Cardiac rehabilitation (CR) is effective in prolonging survival and reducing disability in patients with coronary heart disease. However, national use patterns and predictors of CR use have not been evaluated thoroughly...

..Furthermore, the longitudinal profiles developed are easily interpreted and flexible, making them of practical use to policy-makers...

..To compare process of care and outcome after acute myocardial infarction, for patients with and without mental illness, cared for in the Veterans Health Administration (VA) health care system...

..CONCLUSIONS: Despite increased case selection at hospitals with on-site cardiac services, there was no evidence of increase in the survival rate associated with angiography use at these hospitals...

..16 and 0.20. The results were generally robust for short- and long stayers, and for persons admitted early and late after the change in payment mechanism. The model controlled for hospital fixed effects and individual random effects...

..We also present two methods to identify hospitals with superior performance. The methods are illustrated using national data collected to evaluate quality of care delivered by the U.S. acute care hospitals...

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..After adjusting for many patient and hospital characteristics, however, variation in PASU remained across States...

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..We set out to describe and assess methods for estimation of a treatment effect when the trial is 'broken'...

..A model using administrative claims data that is suitable for profiling hospital performance for heart failure would be useful in quality assessment and improvement efforts...

..We sought to develop a hierarchical regression model using Medicare claims data that produces hospital risk-standardized 30-day mortality rates and to validate the hospital estimates against those derived from a medical record model...

..The plans were encouraged to manage care...

..Multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates, are needed to more fully characterize hospital performance...

..These findings suggest that recent innovations in heart failure management have not yet translated into better outcomes in this population...

..This transfer of costs from a less to a more generous plan increases the burden of adverse selection. Our data suggest that switching may be more important to the level of premiums than previously documented...

..There was no evidence of cost shifting. Although emphasis on outpatient treatment did not result in cost shifting, the combination of substance use disorder and psychiatric illness remains an expensive public health problem...

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..Recent developments in the methodology and standards for outcomes measurement have laid the groundwork for incorporating outcomes into performance monitoring efforts for these conditions...

..We examine the implications of these findings for the millions of vulnerable Americans who rely on safety-net hospitals for their care...

..Further work should focus on how regionalization policies could be improved with effective referral and triage processes...

..We also illustrate the use of discrete choice models to estimate the effect of antipsychotic drug use on the risk of diabetes in a cohort of adults with schizophrenia...

..The methodological advances from this research will enable mental health researchers and policy makers to better characterize usual care and to expand the inferences drawn from clinical trials. ..

..The methodological advances from this research will enable researchers, policy makers, and methodologists to better characterize factors impacting technology innovation/exnovation and to expand the inferences for usual care. ..

..These novel and innovative methods will improve the assessment of treatment effects and will contribute to improving the health of the population. ..