NCQA Research Publications

2008

Solberg LI, Asche SE, Pawlson LG, Scholle SH, Shih SC. Practice Systems Are Associated with High-quality Care for Diabetes. Am J Manag Care. 2008;14:85-92.

OBJECTIVE: To determine whether a questionnaire that assesses the presence of practice systems is associated with clinical performance rates for diabetes care. STUDY DESIGN: Cross-sectional study of the relation between a survey-based measure of practice systems within 5 of the domains of the chronic care model (CCM) and high-quality care for diabetes during 2005 among 40 medical groups in Minnesota. METHODS: Correlations were calculated between (1) practice systems as measured by the Physician Practice Connections–Readiness Survey (PPC-RS) questionnaire and (2) process and outcome measures of diabetes quality from a standardized system managed by Minnesota Community Measurement. RESULTS: Most process and outcome measures were correlated at 0.31 to 0.52 (P <.05) with the PPC-RS total score as well as with several of the CCM domains. Only yearly eye exams and blood pressure control lacked correlation with any CCM domain, but delivery system redesign and self management support lacked correlation with quality measures. CONCLUSIONS: As measured by the PPC-RS questionnaire, the presence of practice systems overall and within several domains of the CCM was associated with high-quality care for diabetes. The PPC-RS may be a useful and relatively simple tool for evaluating and guiding improvement of practice systems for diabetes care quality.

Horgan CM, Merrick EL, Stewart MT, Scholle SH, Shih S. Improving Medication Management of Depression in Health Plans. Psychiatric Services. 2008 Jan;59(1):72-77.

OBJECTIVE: Improving depression treatment is critical given low rates of appropriate care. Health plan performance measures that address quality of antidepressant medication management, specifically, have been stagnating at relatively low levels. Identifying health plan characteristics associated with better performance could contribute to quality improvement for this aspect of depression treatment. METHODS: Data for 2003 were linked from two sources: a nationally representative survey of 368 health plans about their behavioral health services and the National Committee for Quality Assurance’s Health Plan Employer Data and Information Set (HEDIS) antidepressant medication management (AMM) scores, which reflect the percentage of eligible members whose care met specified criteria. The analytic sample present in both data sets totaled 361 products offered by 183 plans. Plan characteristics were grouped into organizational, provider and consumer domains. Bivariate tests and regression analyses were conducted to estimate the relationship between these characteristics and health plan performance on three AMM measures: effective acute-phase treatment, effective continuation-phase treatment, and optimal practitioner contact. RESUTS: Mean HEDIS AMM scores were 60% for effective acute-phase treatment, 43% for continuation-phase treatment and 22% for optimal practitioner contact. Individual feedback to clinicians about their performance, lower cost sharing for outpatient mental health, and greater access to selective serotonin reuptake inhibitors were significantly associated with better plan performance in terms of antidepressant medication management. CONCLUSIONS: Health plan characteristics were significantly associated with the quality of one important aspect of depression care, antidepressant medication management. Many of the factors that were identified suggest actionable ways for plans to improve quality of depression care.

2007

Bardenheier B, Kong Y, Shefer A, Zhou F, Shih S. Managed Care Organizations’ Performance in Delivery of Childhood Immunizations (HEDIS, 1999-2002). Am J Manag Care. 2007;13:193-200

OBJECTIVE: To examine recent trends in childhood immunizations recommended by the Advisory Committee for Immunization Practices measured by the Health Plan Employer Data and Information Set (HEDIS) and to describe the factors associated with higher rates over time. DESIGN: The HEDIS performance measures from 1999 to 2002 and plan characteristics include approximately 400 enrollees per plan each year. METHODS: Longitudinal regression analysis of commercial managed care organizations’ HEDIS measures. The outcome measure was the proportion of children aged 24 to 35 months in the plan who received 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of polio vaccine, 1 dose of measles-mumps-rubella vaccine, 3 doses of Haemophilus influenzae type b vaccine, and 3 doses of hepatitis B vaccine. RESULTS: The mean immunization rate for health insurance plans increased from 65.7% in 1999 to 67.9% to 2002. Plans that reported publicly had higher childhood immunization rates than plans that did not report publicly (P < .001). Plans with higher proportions of Hispanics or African Americans had lower childhood immunization rates (P < .001). Immunization rates varied significantly by type of visit; plans with higher proportions of children making visits to their primary care physician had higher rates of immunization (P < .001). CONCLUSION: Managed care organizations’ performance measured by childhood immunization rates varies by organizational and demographic factors. Our findings suggest that plans should ensure efficient and accurate data collection systems and should encourage their providers to assess for immunizations at sick-child and well-child care visits.

Chou AF, Brown AF, Jensen RE, Shih S, Pawlson LG, Scholle SH. Gender and Racial Disparities in the Management of Diabetes Mellitus Among Medicare Patients. Women’s Health Issues 17 (2007) 150–161

BACKGROUND: Racial/ethnic disparities in diabetes care have been demonstrated in several settings, but few studies have evaluated whether racial/ethnic differences vary by gender. The objective of this study is to understand gender and racial effects on diabetes care for Medicare managed care beneficiaries. METHODS: Using data from: (1) Healthcare Effectiveness Data and Information Set (HEDIS®); (2) Medicare Enrollment Files; and (3) U.S. Census, hierarchical generalized linear analyses were conducted to model the six HEDIS comprehensive diabetes care quality indicators, including processes of care and intermediate outcome measures, as a function of gender and race/ethnicity. RESULTS: Women were more likely to have received HbA1c screening or eye examination, but less likely to have LDL control at <100 mg/dL, compared to men. Racial disparities favored whites in five measures, where African Americans were less likely to have received HbA1c screening, eye examination, cholesterol screening, or achieve adequateHbA1c control or LDL control at<100 mg/dL. Enrollees in managed care plans where African Americans constituted more than 20% of their insured population tended to have lower likelihood of meeting the HbA1c screening, HbA1c control, and eye examination measures. CONCLUSIONS AND DISCUSSION: Gender and racial disparities in performance indicators were present among persons enrolled in Medicare managed care. White women were more likely to have met the performance measures related to process of care, but African Americans fared worse in both process of care and intermediate health outcome measures, compared to their white counterparts. Poor performance in cholesterol control observed in women of both races suggests the possibility of less intensive cholesterol treatment in women. The differences in the pattern of care demonstrate the need for interventions tailored to address gender and race/ethnicity.

Chou AF, Wong L, Weisman CS, Chan S, Bierman AS, Correa-de-Araujo R, Scholle SH. Gender Disparities in Cardiovascular Disease Care among Commercial and Medicare Managed Care Plans. Women’s Health Issues 17 (2007) 139–149

BACKGROUND. Gender disparities in cardiovascular care have been documented in studies of patients, but little is known about whether these disparities persist among managed health care plans. This study examined 1) the feasibility of gender-stratified quality of care reporting by commercial and Medicare health plans; 2) possible gender differences in performance on prevention and treatment of cardiovascular disease in US health plans; and 3) factors that may contribute to disparities as well as potential opportunities for closing the disparity gap. METHODS. We evaluated plan-level performance on Healthcare Effectiveness Data and Information Set (HEDIS®) measures using a national sample of commercial health plans that voluntarily reported gender-stratified data and for all Medicare plans with valid member-level data that allowed the computation of gender-stratified performance data. Key informant interviews were conducted with a subset of commercial plans. Participating commercial plans in this study tended to be larger and higher performing than other plans who routinely report on HEDIS performance. RESULTS. Nearly all Medicare and commercial plans had sufficient numbers of eligible members to allow for stable reporting of gender-stratified performance rates for diabetes and hypertension, but fewer commercial plans were able to report gender-stratified data on measures where eligibility was based on recent cardiac events. Over half of participating commercial plans showed a disparity of >5% in favor of men for cholesterol control measures among persons with diabetes and persons with a recent cardiovascular procedure or heart attack, whereas no commercial plans showed such disparities in favor of women. These gender differences favoring men were even larger for Medicare plans, and disparities were not linked to health plan performance or region. CONCLUSIONS AND DISCUSSION. Eliminating gender disparities in selected cardiovascular disease preventive quality of care measures has the potential to reduce major cardiac events including death by 4,785–10,170 per year among persons enrolled in US health plans. Health plans should be encouraged to collect and monitor quality of care data for cardiovascular disease for men and women separately as a focus for quality improvement.

Chou AF, Scholle SH, Weisman CS, Bierman AS, Correa-de-Araujo R, Mosca L. Gender Disparities in the Quality of Cardiovascular Disease Care in Private Managed Care Plans. Women’s Health Issues 17 (2007) 120–130

BACKGROUND. Studies have shown that women with cardiovascular disease (CVD) are screened and treated less aggressively than men and are less likely to undergo cardiac procedures. Research in this area has primarily focused on the acute setting, and there are limited data on the ambulatory care setting, particularly among the commercially insured. To that end, the objective of this study is to determine if gender disparities in the quality of CVD care exist in commercial managed care populations. METHODS. Using a national sample of commercial health plans, we analyzed member-level data for 7 CVD quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS®) collected in 2005. We used hierarchical generalized linear models to estimate these HEDIS measures as a function of gender, controlling for race/ethnicity, socioeconomic status, age, and plans’ clustering effects. RESULTS. Results showed that women were less likely than men to have low-density lipoprotein (LDL) cholesterol controlled at <100 mg/dL in those who have diabetes (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76–0.86) or a history of CVD (OR, 0.72; CI 95%, 0.64–0.82). The difference between men and women in meeting the LDL control measures was 5.74% among those with diabetes (44.3% vs. 38.5%) and 8.53% among those with a history of CVD (55.1% vs. 46.6%). However, women achieved higher performance than men in controlling blood pressure (OR, 1.12; 95% CI, 1.02–1.21), where the rate of women meeting this quality indicator exceeded that of men by 1.94% (70.8% for women vs. 68.9% for men). CONCLUSIONS. Gender disparities in the management and outcomes of CVD exist among patients in commercial managed care plans despite similar access to care. Poor performance in LDL control was seen in both men and women, with a lower rate of control in women suggesting the possibility of less intensive cholesterol treatment in women. The differences in patterns of care demonstrate the need for interventions tailored to address gender disparities

Landon BE, Schneider EC, Normand SLT, Scholle SH, Pawlson LG, Epstein AM. Quality of Care in Medicaid Managed Care and Commercial Health Plans. JAMA. 2007;298(14):1674-1681

CONTEXT: In contrast to the commercially insured population, the proportion of Medicaid beneficiaries enrolling in health maintenance organizations continues to increase. OBJECTIVE: To compare quality of care within and between the Medicaid and commercial populations in 3 types of managed care plans: Medicaid-only plans (serving predominantly Medicaid enrollees), commercial-only plans (serving predominantly commercial enrollees), and Medicaid/commercial plans (serving substantial numbers of both types of enrollees). DESIGN, SETTING AND PARTICIPANTS: All 383 health plans that reported quality-of care data to the National Committee for Quality Assurance for 2002 and 2003, including 204 commercial-only plans, 142 Medicaid/commercial plans (plans reported data for the Medicaid and commercial populations separately); and 37 Medicaid-only plans. MAIN OUTCOME MEASURES: Eleven quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS) applicable to the Medicaid population. RESULTS: Among Medicaid enrollees, performance on the 11 measures observed in this study were comparable for Medicaid-only plans and Medicaid/commercial plans. Similarly, among commercial enrollees, there was virtually no difference in performance between health plans that served only the commercial population and those that also served the Medicaid population. Overall across all health plan types, the performance for the commercial population exceeded the performance for the Medicaid population on all measures except 1, ranging from a difference of 4.9% for controlling hypertension (58.4% for commercial vs 53.5% for Medicaid; P=.002) to 24.5% for rates of appropriate postpartum care (77.2% for commercial vs 52.7% for Medicaid; P=.001). Differences of similar magnitude were observed for commercial and Medicaid populations treated within the same health plan. CONCLUSIONS: Medicaid managed care enrollees receive lower-quality care than that received by commercial managed care enrollees. There were no differences in quality of care for the Medicaid population between Medicaid-only plans and commercial plans that also served the Medicaid population.

Plomondon ME, Magid DJ, Steiner JF, MaWhinney S, Gifford BD, Shih SC, Grunwald GK, Rumsfeld JS. Primary Care Provider Turnover and Quality in Managed Care Organizations. Am J Manag Care. 2007;13:465-472

OBJECTIVES: To examine the association between primary care provider turnover in managed care organizations and measures of member satisfaction and preventive care. STUDY DESIGN: Retrospective cohort study of a national sample of 615 managed care organizations that reported HEDIS® data to the National Committee for Quality Assurance from 1999 through 2001. METHODS: Multivariable hierarchical regression modeling was used to evaluate the association between health plan primary care provider turnover rate and member satisfaction and preventive care measures, including childhood immunization, well-child visits, cholesterol, diabetes management, and breast and cervical cancer screening, adjusting for patient and organizational characteristics, time, and repeated measures. RESULTS: The median primary care provider turnover rate was 7.1% (range, 0%-53.3%). After adjustment for plan characteristics, health plans with higher primary care provider turnover rates had significantly lower measures of member satisfaction, including overall rating of healthcare (P < .01). A 10% higher primary care provider turnover rate was associated with 0.9% fewer members rating high overall satisfaction with healthcare. Health plans with higher provider turnover rates also had lower rates of preventive care, including childhood immunization (P = .045), well-child visits (P = .002), cholesterol screening after cardiac event (P = .042), and cervical cancer screening (P = .024). For example, a 10% higher primary care provider turnover was associated with a 2.7% lower rate of child-members receiving  well-child visits in the first 15 months of life. CONCLUSIONS: Primary care provider turnover is associated with several measures of care quality, including aspects of member satisfaction and preventive care. Future studies should evaluate whether interventions to reduce primary care provider turnover can improve quality of care and patient outcomes.

Pawlson LG. Health Information Technology: Does It Facilitate Or Hinder Rapid Learning? Health Aff (Millwood). 2007 Jan 26; PMID: 17259201

Abstract: Health information technology presents major challenges as well as opportunities in creating care that fulfills the Institute of Medicine's aims of being safe, timely, effective, efficient, equitable, and patient-centered. This commentary examines the barriers that relate directly to the collection and use of information in practice, and it explores some of the possible solutions.
 
Virnig BA, Scholle SH, Chou AF, Shih S. Efforts to reduce racial disparities in Medicare managed care must consider the disproportionate effects of geography. Am J Manag Care. 2007 Jan;13(1):51-6. PMID: 17227203  

OBJECTIVE: To examine the impact of geographic variation on racial differences in 7 of 15 Health Plan Employer Data and Information Set (HEDIS) measures that assess the quality of the Medicare managed care program (also known as Medicare+Choice). STUDY DESIGN: Cross-sectional analysis using the 2004 individual-level HEDIS for Medicare managed care plans and 2003 Medicare enrollment and demographic (ie, denominator) data for more than 5.1 million Medicare+Choice enrollees. METHODS: Individual-level HEDIS data were linked with Medicare enrollment data. Hierarchical generalized linear models were used to assess statistical significance of region and race. Direct standardization was used to estimate the rate of meeting each HEDIS standard while controlling for differences in age and sex. RESULTS: Quality of care for white Medicare+Choice enrollees was strongly correlated with the racial composition of the geographic area. Except for cholesterol management after an acute cardiac event, between-region racial variation was consistently greater than within-region racial variation. CONCLUSION: Removing within-region racial variation while ignoring geographic differences will not equalize the experiences of black and white elders. Rather, both racial and geographic components of healthcare quality must be addressed if the Medicare managed care program is to provide care of equal quality to all elders regardless of race.

Pawlson LG. Health Information Technology: Does It Facilitate Or Hinder Rapid Learning? Health Aff (Millwood). 2007 Jan 26; PMID: 17259201

Abstract: Health information technology presents major challenges as well as opportunities in creating care that fulfills the Institute of Medicine's aims of being safe, timely, effective, efficient, equitable, and patient-centered. This commentary examines the barriers that relate directly to the collection and use of information in practice, and it explores some of the possible solutions.

Virnig BA, Scholle SH, Chou AF, Shih S. Efforts to reduce racial disparities in Medicare managed care must consider the disproportionate effects of geography. Am J Manag Care. 2007 Jan;13(1):51-6. PMID: 17227203  

OBJECTIVE: To examine the impact of geographic variation on racial differences in 7 of 15 Health Plan Employer Data and Information Set (HEDIS) measures that assess the quality of the Medicare managed care program (also known as Medicare+Choice). STUDY DESIGN: Cross-sectional analysis using the 2004 individual-level HEDIS for Medicare managed care plans and 2003 Medicare enrollment and demographic (ie, denominator) data for more than 5.1 million Medicare+Choice enrollees. METHODS: Individual-level HEDIS data were linked with Medicare enrollment data. Hierarchical generalized linear models were used to assess statistical significance of region and race. Direct standardization was used to estimate the rate of meeting each HEDIS standard while controlling for differences in age and sex. RESULTS: Quality of care for white Medicare+Choice enrollees was strongly correlated with the racial composition of the geographic area. Except for cholesterol management after an acute cardiac event, between-region racial variation was consistently greater than within-region racial variation. CONCLUSION: Removing within-region racial variation while ignoring geographic differences will not equalize the experiences of black and white elders. Rather, both racial and geographic components of healthcare quality must be addressed if the Medicare managed care program is to provide care of equal quality to all elders regardless of race.

2006

Bean-Mayberry B, Chang CC, Scholle SH. Brief report: lack of a race effect in primary care ratings among women veterans. J Gen Intern Med. 2006 Oct;21(10):1105-8.  PMID: 16970560  

OBJECTIVE: To explore the effect of race on primary care quality and satisfaction among women in the Department of Veterans Affairs (VA). METHODS: We used a mail survey to measure primary care quality and satisfaction. We focused on 4 primary care domains: patient preference for provider, interpersonal communication, accumulated knowledge, and coordination. We performed univariate analyses to compare variables by race and multiple logistic regression analysis to examine the effect of race on the probability of reporting a perfect score on each domain, while adjusting for patient characteristics and site. RESULTS: Black women were younger, unmarried, educated, of higher income, and reported female providers and gynecological care in VA more often. In regression analysis, race was not significantly associated with any primary care domain or satisfaction. Gynecological care from VA provider was associated with perfect ratings on patient preference for provider (odds ratio [OR] 2.0, 95% confidence intervals [CI] 1.3, 3.1), and satisfaction (OR 1.6, 95% CI 1.2, 2.3), while female provider was associated with interpersonal communication (OR 1.9, 95% CI 1.4, 2.6). CONCLUSIONS: While demographics and health experiences vary by race among veterans, race had no effect on primary care ratings. Future studies need to determine whether this racial equity persists in health outcomes among women veterans.

Bean-Mayberry BA, Chang CC, McNeil MA, Scholle SH. Ensuring high-quality primary care for women: predictors of success. Womens Health Issues. 2006 Jan-Feb;16(1):22-9.  PMID: 16487921   

BACKGROUND: Provider gender, provider specialty, and clinic setting affect quality of primary care delivery for women, but previous research has not examined these factors in combination. The purpose of this study is to determine whether separate or combined effects of provider gender, availability of gynecologic services from the provider, and women's clinic setting improve patient ratings of primary care. METHODS: Women veterans receiving care in women's clinics or traditional primary care at 10 Veteran's Affair (VA) medical centers completed a mailed questionnaire (N = 1321, 61%) rating four validated domains of primary care (preference for provider, communication, coordination, and accumulated knowledge). For each domain, summary scores were calculated and dichotomized into perfect score (maximum score) versus other. Multiple logistic regressions were used to estimate the probability of a perfect score in each domain while controlling for patient characteristics and site. RESULTS: Female provider was significantly associated with perfect ratings for communication and coordination. Providing gynecologic care was significantly associated with perfect ratings for male and female providers. Patients who used a women's clinic and had a female provider who gave gynecologic care had perfect or nearly perfect ratings for preference for provider, communication, and accumulated knowledge. CONCLUSION: Gynecologic services are linked to patient ratings of primary care separate from and in synergy with the effect of female provider. Male and female providers should consider offering routine gynecologic services or working in coordination with a setting that provides gynecologic services. Health care evaluations should assess scope of services for provider and practice.

Chang JC, Dado D, Ashton S, Hawker L, Cluss PA, Buranosky R, Scholle SH. Understanding behavior change for women experiencing intimate partner violence: mapping the ups and downs using the stages of change. Patient Educ Couns. 2006 Sep;62(3):330-9. Epub 2006 Jul 24.  PMID: 16860522  

OBJECTIVE: For women who are experiencing intimate partner violence (IPV), making changes toward safety is often a gradual process. When providing counseling and support, health care providers may benefit from better understanding of where women are in their readiness to change. Our objective was to apply the transtheoretical model's stages of change to the experiences of women who experienced IPV and map their experiences of change as they moved toward increased safety. METHODS: A multi-disciplinary team designed a qualitative interview process with 20 women who had current or past histories of IPV in order to explore their experiences. RESULTS: The women in our study (1) moved through stages of readiness generally in a nonlinear fashion, with varying rates of progression between safe and nonsafe situations, (2) were able to identify a "turning-point" in their situations, (3) attempted multiple "action" steps and (4) were influenced by internal and external factors. CONCLUSIONS: Our study suggests that focusing on the transtheoretical model to develop stage-based interventions for IPV may not be the most appropriate given the nonsequential movement between stages and influence of external factors. PRACTICE IMPLICATIONS: The "change mapping" technique can be used as an educational and counseling tool with patients, as well as a training tool for health care providers.

Cluss PA, Chang JC, Hawker L, Scholle SH, Dado D, Buranosky R, Goldstrohm S.  The process of change for victims of intimate partner violence: support for a psychosocial readiness model.Womens Health Issues. 2006 Sep-Oct;16(5):262-74.  PMID: 17055379  

Intimate partner violence (IPV) victimization is a women's health problem that imposes a significant health and health care cost burden. Although IPV victims cannot change the perpetrator's behavior, they can take actions to reduce exposure to the partner's abuse. The process of change for IPV victims has been described using the transtheoretical model (TTM), among others. We report results of a qualitative study with current and past IPV victims to 1) explicate the process of safety-seeking behavior change for female victims of IPV and 2) explore the fit of the TTM for explaining this process. Based on the results, we propose the psychosocial readiness model to describe the process of change for female victims of IPV. This model considers readiness as a continuum that ranges from robustly defending the status quo on 1 end to being ready to take action toward change on the other. Movement toward and away from change along the continuum results from a dynamic interplay of both internal factors and external interpersonal and situational factors.

Mardon RE, Halim S, Pawlson LG, Haffer SC.  Management of urinary incontinence in Medicare managed care beneficiaries: results from the 2004 Medicare Health Outcomes Survey. Arch Intern Med. 2006 May 22;166(10):1128-33.  PMID: 16717176  

BACKGROUND: Despite the high prevalence of urinary incontinence (UI) among older persons and the existence of effective treatments, UI remains underreported by patients and underdiagnosed by clinicians. We measured the occurrence of UI problems in Medicare managed care beneficiaries, frequency of physician-patient communication regarding UI, and frequency of UI treatment. METHODS: We used cross-sectional data from the 2004 Medicare Health Outcomes Survey, which measured self-reported UI (accidental leakage of urine) and UI problems in the past 6 months, 36-Item Short-Form Health Survey health measures, discussions of UI with a health care provider, and receipt of UI treatment. RESULTS: The overall incidence of UI within the past 6 months was 37.3%, consistent with previous estimates. Problems with UI were strongly associated with poorer self-reported health. Mean 36-Item Short-Form Health Survey physical and mental health scores were lower by more than 5 points (on a 100-point scale, P<.001) for respondents with major UI problems when controlling for age, sex, race, Hispanic ethnicity, and major comorbidities. These differences were among the largest of any condition measured. Only 55.5% of those with self-reported UI problems reported discussing these problems during their recent visit to a physician or other health care provider. The rate of patient-reported UI treatment was 56.5% and was lower (P<.001) for older individuals (eg, 46.3% for those aged 90-94 years) or those with poor self-reported health status (50.5%). CONCLUSIONS: Among older persons, UI is common, underdiagnosed, and associated with substantial functional impairment. There appears to be considerable opportunity to mitigate the effects of UI on health and quality of life among community-dwelling older persons.

Selim AJ, Kazis LE, Rogers W, Qian S, Rothendler JA, Lee A, Ren XS, Haffer SC, Mardon R, Miller D, Spiro A 3rd, Selim BJ, Fincke BG.  Risk-adjusted mortality as an indicator of outcomes: comparison of the Medicare Advantage Program with the Veterans' Health Administration. Med Care. 2006 Apr;44(4):359-65. PMID: 16565637

BACKGROUND: The Medicare Advantage Program (MAP) and the Veterans' Health Administration (VHA) currently provide many services that benefit the elderly, and a comparative study of their risk-adjusted mortality rates has the potential to provide important information regarding these 2 systems of care. OBJECTIVE: The objective of this retrospective study was to compare mortality rates between the MAP and the VHA after controlling for case-mix differences. SUBJECTS: This study consisted of 584,294 MAP patients and 420,514 VHA patients. MEASURES: We used the Death Master File to ascertain the vital status of each study subject over approximately 4 years. We used Cox regression models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the MAP compared with VHA patients. RESULTS: The average age for male MAP patients was 73.8 years (+/- 5.6) and for male VHA patients was 74.05 years (+/- 6.3). Unadjusted mortality rates of males for VHA and MAP were 25.7% and 22.8%, respectively, over approximately 4 years (P < 0.0001), respectively. The case-mix of VHA patients, however, was sicker than those from MAP. After adjusting for case-mix, the HR for mortality in the MAP was significantly higher than that in the VHA (HR, 1.404; 95% CI = 1.383-1.426). We obtained similar results when we compared the mortality rates of females for VHA and MAP. CONCLUSIONS: After adjusting for their higher prevalence of chronic disease and worse self-reported health, mortality rates were lower for patients cared for in the VHA compared with those in the MAP. Further studies should examine what differences in care structures and processes contribute to lower mortality in the VHA.

2005

Chang JC, Cluss PA, Ranieri L, Hawker L, Buranosky R, Dado D, McNeil M, Scholle SH.  Health care interventions for intimate partner violence: what women want. Womens Health Issues. 2005 Jan-Feb;15(1):21-30. PMID: 15661584  

Dziak K, Anderson R, Sevick MA, Weisman CS, Levine DW, Scholle SH.  Variations among Institutional Review Board reviews in a multisite health services research study. Health Serv Res. 2005 Feb;40(1):279-90.  PMID: 15663713  

Mangione-Smith R, Wong L, Elliott MN, McDonald L, Roski J. Measuring the quality of antibiotic prescribing for upper respiratory infections and bronchitis in 5 US health plans. Arch Pediatr Adolesc Med. 2005 Aug;159(8):751-7.  PMID: 16061783  

Mangione-Smith R, Elliott MN, Wong L, McDonald L, Roski J.   Measuring the quality of care for group A streptococcal pharyngitis in 5 US health plans.Arch Pediatr Adolesc Med. 2005 May;159(5):491-7. PMID: 15867126  

Pawlson LG, Torda P, Roski J, O'Kane ME.  The role of accreditation in an era of market-driven accountability. Am J Manag Care. 2005 May;11(5):290-3.  PMID: 15898217  

Solberg LI, Scholle SH, Asche SE, Shih SC, Pawlson LG, Thoele MJ, Murphy AL. Practice systems for chronic care: frequency and dependence on an electronic medical record. Am J Manag Care. 2005 Dec;11(12):789-96.  PMID: 16336063  

Scholle SH, Mardon R, Shih SC, Pawlson LG.  The relationship between quality and utilization in managed care. Am J Manag Care. 2005 Aug;11(8):521-7.  PMID: 16095438  

Scholle SH.  NCQA behavioral health measurement efforts. J Manag Care Pharm. 2005 Apr;11(3 Suppl):S9-11. Review.  PMID: 15804202  

Solberg LI, Scholle SH, Asche SE, Shih SC, Pawlson LG, Thoele MJ, Murphy AL. Practice systems for chronic care: frequency and dependence on an electronic medical record. Am J Manag Care. 2005 Dec;11(12):789-96.  PMID: 16336063  

Wren FJ, Scholle SH, Heo J, Comer DM.  How do primary care clinicians manage childhood mood and anxiety syndromes? Int J Psychiatry Med. 2005;35(1):1-12.  PMID: 15977941  

Pisu M, James N, Sampsel S, Saag KG.  The cost of glucocorticoid-associated adverse events in rheumatoid arthritis. Rheumatology (Oxford). 2005 Jun;44(6):781-8. Epub 2005 Mar 15. PMID: 15769791  

2004

Bean-Mayberry B, Chang CC, McNeil M, Hayes P, Scholle SH.  Comprehensive care for women veterans: indicators of dual use of VA and non-VA providers. J Am Med Womens Assoc. 2004 Summer;59(3):192-7.  PMID: 15354372  

Druss BG, Miller CL, Pincus HA, Shih S.  The volume-quality relationship of mental health care: does practice make perfect? Am J Psychiatry. 2004 Dec;161(12):2282-6. PMID: 15569901  
Harman JS, Scholle SH, Edlund MJ.  Emergency department visits for depression in the United States. Psychiatr Serv. 2004 Aug;55(8):937-9.  PMID: 15292546  

Hibbard J, Pawlson LG.  Why not give consumers a framework for understanding quality? Jt Comm J Qual Saf. 2004 Jun;30(6):347-51.  PMID: 15208985  

Heflinger CA, Simpkins CG, Scholle SH, Kelleher KJ.  Parent/caregiver satisfaction with their child's Medicaid plan and behavioral health providers. Ment Health Serv Res. 2004 Mar;6(1):23-32.  PMID: 15002678  

Lipsy RJ, Fuller MG, Roski J, Mansukani S.  Anticipating the future: how the emergence of innovative biologic agents impacts benefit design, utilization, and provider relations. J Manag Care Pharm. 2004 May;10(3 Suppl):S4-9; quiz S19. PMID: 15228370  

MacLean CH, Saag KG, Solomon DH, Morton SC, Sampsel S, Klippel JH.  Measuring quality in arthritis care: methods for developing the Arthritis Foundation's quality indicator set. Arthritis Rheum. 2004 Apr 15;51(2):193-202. PMID: 15077259  

Pawlson LG, O'Kane ME.  Malpractice prevention, patient safety, and quality of care: a critical linkage. Am J Manag Care. 2004 Apr;10(4):281-4. Review.  PMID: 15124505  

Pawlson G, Scholle SH, Renner P.  Pitfalls of converting practice guidelines into quality measures. JAMA. 2004 Sep 15;292(11):1301; author reply 1302. No abstract available.  PMID: 15367545  

Rickert D, Deladisma A, Yusuf H, Averhoff F, Brink E, Shih S.   Adolescent immunizations. are we ready for a new wave? Am J Prev Med. 2004 Jan;26(1):22-8.  PMID: 14700708  

Scholle SH, Weisman CS, Anderson RT, Camacho F.  The development and validation of the primary care satisfaction survey for women. Womens Health Issues. 2004 Mar-Apr;14(2):35-50.  PMID: 15120413  

Scholle SH, Chang J, Harman J, McNeil M.  Characteristics of patients seen and services provided in primary care visits in obstetrics/gynecology: data from NAMCS and NHAMCS. Am J Obstet Gynecol. 2004 Apr;190(4):1119-27.  PMID: 15118652  

Thom DH, Hall MA, Pawlson LG.  Measuring patients' trust in physicians when assessing quality of care. Health Aff (Millwood). 2004 Jul-Aug;23(4):124-32. Review.  PMID: 15318572  

2003

Scholle SH, Wong L, Roski J.  Validation of data collection for the HEDIS performance measure on Chlamydia screening in a MCO. Am J Manag Care. 2003 Nov;9(11):713, 776; author reply 776. No abstract available.  PMID: 14626469  

Roski J, Jeddeloh R, An L, Lando H, Hannan P, Hall C, Zhu SH.   The impact of financial incentives and a patient registry on preventive  care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Prev Med. 2003 Mar;36(3):291-9.  PMID: 12634020  

Mangione-Smith R, Onstad K, Wong L, Roski J.  Deciding not to measure performance: the case of acute otitis media. Jt Comm J Qual Saf. 2003 Jan;29(1):27-36. PMID: 12528571  

Shih SC, Bost JE, Pawlson LG.  Standardized health plan reporting in four areas of preventive health care. Am J Prev Med. 2003 May;24(4):293-300.  PMID: 12726866  

Pawlson LG.  Measures and systems: a new formulation of managed care? Am J Manag Care. 2002 Jul;Suppl Decision Maker News:5, 8. No abstract available.  PMID: 12608006  

Pawlson LG.  Public disclosure of health plan quality of care. JAMA. 2003 Feb 19;289(7):845-6; author reply 847. No abstract available.  PMID: 12588265  

2002

Anderson RT, Weisman CS, Scholle SH, Henderson JT, Oldendick R, Camacho F.  Evaluation of the quality of care in the clinical care centers of the National Centers of Excellence in Women's Health. Womens Health Issues. 2002 Nov-Dec;12(6):309-26.  PMID: 12457572  

Ashton MR, Cook RL, Wiesenfeld HC, Krohn MA, Zamborsky T, Scholle SH, Switzer GE.  Primary care physician attitudes regarding sexually transmitted diseases. Sex Transm Dis. 2002 Apr;29(4):246-51.  PMID: 11912468  

Bost JE, Thompson JW, Shih S, Pinidiya SD, Ryan KW.  Differences in health care quality for children and adults under managed care: justification for separate quality assessments? Ambul Pediatr. 2002 May-Jun;2(3):224-9.  PMID: 12014984  

Gardner W, Pajer KA, Kelleher KJ, Scholle SH, Wasserman RC.  Child sex differences in primary care clinicians' mental health care of children and adolescents. Arch Pediatr Adolesc Med. 2002 May;156(5):454-9.  PMID: 11980550  

Fletcher RH, Colditz GA, Pawlson LG, Richman H, Rosenthal D, Salber PR.  Screening for colorectal cancer: the business case. Am J Manag Care. 2002 Jun;8(6):531-8.  PMID: 12068960  

Lave JR, Peele PB, Xu Y, Scholle SH, Pincus HA. An exploratory analysis of behavioral health care use within families. Psychiatr Serv. 2002 Jun;53(6):743-8.  PMID: 12045313  

Pawlson LG.  Hope for enhanced efficiency. Health Aff (Millwood). 2002 Sep-Oct;21(5):302-3; author reply 303. No abstract available.  PMID: 12224900  

Pawlson LG, O'Kane ME.  Professionalism, regulation, and the market: impact on accountability for quality of care. Health Aff (Millwood). 2002 May-Jun;21(3):200-7.  PMID: 12025985  

Renner PM. NCQA's evolving clinical performance measures.Manag Care. 2002 Sep;11(9 Suppl):19-22.  National Committee for Quality Assurance, USA. PMID: 12369339

Scholle SH, Chang JC, Harman J, McNeil M.  Trends in women's health services by type of physician seen: data from the 1985 and 1997-98 NAMCS. Womens Health Issues. 2002 Jul-Aug;12(4):165-77.  PMID: 12093581  

Swartz HA, Shear MK, Frank E, Cherry CR, Scholle SH, Kupfer DJ.  A pilot study of community mental health care for depression in a supermarket setting. Psychiatr Serv. 2002 Sep;53(9):1132-7. PMID: 12221312  

2001

Cook RL, Wiesenfeld HC, Ashton MR, Krohn MA, Zamborsky T, Scholle SH.  Barriers to screening sexually active adolescent women for chlamydia: a survey of primary care physicians. J Adolesc Health. 2001 Mar;28(3):204-10.  PMID: 11226843  

Cohen-Mansfield J, Lipson S, Brenneman KS, Pawlson LG.  Health status of participants of adult day care centers. J Health Soc Policy. 2001;14(2):71-89.  PMID: 11707026  

Pawlson LG.  Use of consumer surveys. Health Aff (Millwood). 2001 Jul-Aug;20(4):260-2. No abstract available.  PMID: 11463086  

Pawlson LG.  Are we overvaluing performance measures? Eff Clin Pract. 2001 Mar-Apr;4(2):91-2. No abstract available.  PMID: 11329992  

Pawlson LG, Moy EM, Kim JI, Griner PF. A new measure of the impact of managed care on healthcare markets. Am J Manag Care. 2001 Nov;7(11):1069-77.  PMID: 11725810  

Roski J, Gregory R.  Performance measurement for ambulatory care: moving towards a new agenda. Int J Qual Health Care. 2001 Dec;13(6):447-53. PMID: 11769746  

Scholle SH, Gardner W, Harman J, Madlon-Kay DJ, Pascoe J, Kelleher K.  Physician gender and psychosocial care for children: attitudes, practice characteristics,  identification, and treatment. Med Care. 2001 Jan;39(1):26-38.  PMID: 11176541  

2000

DiBartola LM, Moore BB, Pawlson LG.  The Managed Care Education Clearinghouse. Acad Med. 2000 Mar;75(3):302.  PMID: 10724324  

Scholle SH, Peele PB, Kelleher KJ, Frank E, Jansen-McWilliams L, Kupfer D.  Effect of different recruitment sources on the composition of a bipolar disorder case registry. Soc Psychiatry Psychiatr Epidemiol. 2000 May;35(5):220-7.  PMID: 10941997  

Scholle SH, Agatisa PK, Krohn MA, Johnson J, McLaughlin MK.  Locating a health advocate in a private obstetrics/gynecology office increases patient's receipt of preventive recommendations. J Womens Health Gend Based Med. 2000 Mar;9(2):161-5.  PMID: 10746519  

Scholle SH, Weisman CS, Anderson R, Weitz T, Freund KM, Binko J. Women's satisfaction with primary care: a new measurement effort from the PHS National Centers of Excellence in Women's Health. Womens Health Issues. 2000 Jan-Feb;10(1):1-9. Review.  PMID: 10697463