Health services research
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Health services research · Jun 2019
The effects of global budget payments on hospital utilization in rural Maryland.
To assess the effect of Maryland's 2010 Total Patient Revenue (TPR) global budget reform in eight rural hospitals on population-level hospital rates of utilization three years after implementation. ⋯ We find that the TPR reform decreased outpatient utilization but did not affect inpatient utilization.
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Health services research · Apr 2019
Adjusting for social risk factors impacts performance and penalties in the hospital readmissions reduction program.
Medicare's Hospital Readmissions Reduction Program (HRRP) does not account for social risk factors in risk adjustment, and this may lead the program to unfairly penalize safety-net hospitals. Our objective was to determine the impact of adjusting for social risk factors on HRRP penalties. ⋯ Accounting for social risk can have a major financial impact on safety-net hospitals. Adjustment for these factors could reduce negative unintended consequences of the HRRP.
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Health services research · Apr 2019
New approaches to measuring the comprehensiveness of primary care physicians.
To develop claims-based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. ⋯ These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.
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To examine the effects of a harm reduction policy, specifically Good Samaritan (GS) policy, on overdose deaths. ⋯ While we are unable to identify an effect of GS policy on overdose deaths, GS policy may have important effects on first-stage outcomes not investigated in this paper. Given recent state policy changes and rapid increase in many categories of overdose deaths, additional research should continue to examine the implementation and effects of harm reduction policy specifically and substance use prevention policy broadly.
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Health services research · Feb 2019
Geographic context of black-white disparities in Medicare CAHPS patient experience measures.
To examine whether black-white patient experience disparities vary by geography and within-county contextual factors. ⋯ Efforts to reduce black-white disparities in patient experiences should focus on areas with low average patient experiences. Attempts to reduce disparities in timely access to health care should target primarily black, low-income, and racially and economically segregated areas. Positive associations of racial segregation with accessing needed care were unexpected.