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Hillary R. Bogner Heather F. de Vries McClintock Jibby E. Kurichi Pui L. Kwong Dawei Xie Sean Hennessy Joel E. Streim Margaret G. Stineman 《Archives of physical medicine and rehabilitation》2017,98(1):1-10
Objective
To examine how patient satisfaction with care coordination and quality and access to medical care influence functional improvement or deterioration (activity limitation stage transitions), institutionalization, or death among older adults.Design
National representative sample with 2-year follow-up.Setting
Medicare Current Beneficiary Survey from calendar years 2001 to 2008.Participants
Community-dwelling adults (N=23,470) aged ≥65 years followed for 2 years.Interventions
Not applicable.Main Outcome Measures
A multinomial logistic regression model taking into account the complex survey design was used to examine the association between patient satisfaction with care coordination and quality and patient satisfaction with access to medical care and activities of daily living (ADL) stage transitions, institutionalization, or death after 2 years, adjusting for baseline socioeconomics and health-related characteristics.Results
Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted) deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7% weighted) died. Beneficiaries who were in the top quartile of satisfaction with care coordination and quality were less likely to be institutionalized (adjusted relative risk ratio [RRR], .68; 95% confidence interval [CI], .54–.86). Beneficiaries who were in the top quartile of satisfaction with access to medical care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI, .79–.97), be institutionalized (adjusted RRR, .72; 95% CI, .56–.92), or die (adjusted RRR, .86; 95% CI, .75–.98).Conclusions
Knowledge of patient satisfaction with medical care and risk of functional deterioration may be helpful for monitoring and addressing disability-related health care disparities and the effect of ongoing policy changes among Medicare beneficiaries. 相似文献2.
Olivia A. Bernal Heather F. McClintock Jibby E. Kurichi Pui L. Kwong Dawei Xie Joel E. Streim Liliana E. Pezzin Hillary R. Bogner 《Archives of physical medicine and rehabilitation》2019,100(2):289-299
Objective
To examine the association between activity limitation stages and patient satisfaction and perceived quality of medical care among younger Medicare beneficiaries.Design
Cross-sectional study.Setting
Medicare Current Beneficiary Survey (MCBS) for calendar years 2001-2011.Participants
A population-based sample (N=9323) of Medicare beneficiaries <65 years of age living in the community.Interventions
Not applicable.Main Outcome Measures
MCBS questions were categorized under 5 patient satisfaction and perceived quality dimensions: care coordination and quality, access barriers, technical skills of primary care physician (PCP), interpersonal skills of PCP, and quality of information provided by PCP. Persons were classified into an activity limitation stage (0-IV) which was derived from self-reported difficulty performing activities of daily living (ADL) and instrumental activities of daily living (IADL).Results
Compared to beneficiaries with no limitations at ADL stage 0, the adjusted odds ratios (95% confidence intervals) for stage I (mild) to stage IV (complete) for satisfaction with access barriers ranged from 0.62 (0.53-0.72) at stage I to a minimum of 0.31 (0.22-0.43) at stage IV. Similarly, compared to beneficiaries at IADL stage 0, satisfaction with access barriers ranged from 0.66 (0.55-0.79) at stage I to a minimum of 0.36 (0.26-0.51) at stage IV. Satisfaction with care coordination and quality and perceived quality of medical care were not associated with activity limitation stages.Conclusions
Younger Medicare beneficiaries with disabilities reported decreased satisfaction with access to medical care, highlighting the need to improve access to health care and human services and to enhance workforce capacity to meet the needs of this patient population. 相似文献3.
This study models the relationship between Medicare beneficiary decisions to join Medicare HMOs and subsequent health services utilization. The relationship between health plan choice and utilization is thought to be endogenous because of favorable selection into HMOs. Previous studies found significantly lower inpatient utilization among Medicare HMO enrollees than among nonenrollees, but lacked strong controls for selection bias. Thus, a firm conclusion could not be drawn as to whether the observed differences were attributable to the HMO practice setting or to baseline differences in the illness profiles of the two groups studied. The present study uses simultaneous equations methods, including discrete factor estimation, to test the effect of Medicare HMOs on utilization when strong controls for selection bias are imposed. The model was run on a panel of 1993-1996 data from the Medicare Current Beneficiary Survey, supplemented with linked data on Medicare HMO characteristics and area supply characteristics. The study found that even when favorable selection is controlled for, Medicare HMOs significantly reduce both the probability of hospitalization and the number of inpatient days used by those who are hospitalized. Medicare HMOs do not, however, appear to reduce the use of physician services. 相似文献
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Skaar DD O'Connor H Hodges JS Michalowicz BS 《Journal of the American Dental Association (1939)》2011,142(12):1343-1351
BackgroundThe publication of the 2009 American Academy of Orthopedic Surgeons’ (AAOS’) guidelines for antibiotic prophylaxis after joint replacement (arthroplasty) has renewed debate concerning appropriate prophylaxis for dental patients. The authors examined an administrative data set to assess whether dental procedures were associated with prosthetic joint infections (PJIs).MethodsUsing data for the years 1997 through 2006 from the Medicare Current Beneficiary Survey (MCBS), the authors identified participants who had undergone total joint arthroplasty and those who had experienced a PJI. They explored associations between dental procedures and subsequent PJIs by using time-to-event analyses (N = 1,000). A nested case-control study included case participants who had had PJIs (n = 42) and matched control participants who had had total arthroplasty but had no PJIs (n = 126). The authors calculated hazard ratios (HRs) and odds ratios (ORs).ResultsControl participants (people without PJIs) were more likely than were case participants (those with PJIs) to have undergone an invasive dental procedure, though this trend was not statistically significant in either the time-to-event analysis (HR = 0.78; 95 percent confidence interval [CI], 0.18–3.39) or the case-control analysis (OR = 0.56; 95 percent CI, 0.18–1.74). Only four of 42 case participants had undergone an invasive dental procedure in the 90 days before the infection occurred. Consideration of all dental procedures yielded similar results.ConclusionsDental procedures were not associated significantly with subsequent risk for PJIs, although this study's power was somewhat low. The clinical importance of prophylactic antibiotics in dentistry for patients who have undergone joint arthroplasty, therefore, may be questioned.Clinical ImplicationsThese results support the view that the 2009 AAOS Information Statement on antibiotic prophylaxis for people with prosthetic joints should be reconsidered for patients in that population who are receiving oral health care. 相似文献
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Dario Trapani Kiu Tay-Teo Megan E. Tesch Felipe Roitberg Manju Sengar Sara C. Altuna Michael J. Hassett Armando A. Genazzani Aaron S. Kesselheim Giuseppe Curigliano 《Current oncology (Toronto, Ont.)》2022,29(8):5774
Background: Advances in cancer medicines have resulted in tangible health impacts, but the magnitude of benefits of approved cancer medicines could vary greatly. Health Technology Assessment (HTA) is a multidisciplinary process used to inform resource allocation through a systematic value assessment of health technology. This paper reviews the challenges in conducting HTA for cancer medicines arising from oncology trial designs and uncertainties of safety-efficacy data. Methods: Multiple databases (PubMed, Scopus and Google Scholar) and grey literature (public health agencies and governmental reports) were searched to inform this policy narrative review. Results: A lack of robust efficacy-safety data from clinical trials and other relevant sources of evidence has made HTA for cancer medicines challenging. The approval of cancer medicines through expedited pathways has increased in recent years, in which surrogate endpoints or biomarkers for patient selection have been widely used. Using these surrogate endpoints has created uncertainties in translating surrogate measures into patient-centric clinically (survival and quality of life) and economically (cost-effectiveness and budget impact) meaningful outcomes, with potential effects on diverting scarce health resources to low-value or detrimental interventions. Potential solutions include policy harmonization between regulatory and HTA authorities, commitment to generating robust post-marketing efficacy-safety data, managing uncertainties through risk-sharing agreements, and using value frameworks. Conclusion: A lack of robust efficacy-safety data is a central problem for conducting HTA of cancer medicines, potentially resulting in misinformed resource allocation. 相似文献
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