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Clarke, P.S. (2005, November). "Analyzing change based on two measures taken under different conditions." (AHRQ grant HS06516). Statistics in Medicine 24, pp. 3401-3415.

In longitudinal studies, it can be difficult to analyze change in measures from two periods when the measurement conditions are different. In such situations, conditions effects will necessarily be confounded with change between periods. One example is the practice or learning effect, where a participant is tested at each period, but learns to complete the test more effectively on the second occasion. Estimating such conditions effects is impossible without modeling assumptions, note the authors. In this paper, they develop a conditions-effect adjustment model for estimating change effects under different sets of assumptions.

Crofton, C., Darby, C., Farquhar, M., and Clancy, M. (2005, November). "The CAHPS® hospital survey: Development, testing, and use." Journal on Quality and Patient Safety 31(11), pp. 655-659.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) consortium has been developing and testing patient experience surveys since 1995. These surveys include tools for assessment of care given to adults (including Medicare recipients), children, children with special health care needs, and others. This includes care received through managed care, fee-for-service plans, and preferred provider organizations. The article describes how the CAHPS® consortium developed the CAHPS® Hospital Survey instrument, how it was tested, and expectations for its use.

Reprints (AHRQ Publication No. 06-R017) are available from the AHRQ Clearinghouse.

Dudley, R.A. (2005, October). "Pay-for-performance research: How to learn what clinicians and policy makers need to know." (AHRQ grant HS16117). Journal of the American Medical Association 294(14), pp. 1821-1823.

The rationale for pay-for-performance in health care comes almost entirely from experience with incentives in other industries. According to the authors of this paper, pay-for-performance involves a common problem in health service research: despite little evidence, clinicians and policy makers are responding to this major policy trend, while researchers determine how to inform those decision makers. The authors call for strategies that address four fundamental aspects of research: study design, selecting theory-driven hypotheses, reporting research findings in a complete and informative manner, and setting research priorities. They caution that until these issues are clearly addressed, clinicians should be skeptical of any research that purports to describe the impact of pay-for-performance.

Harris, K.M., Edlund, M.J., and Larson, S. (2005, August). "Racial and ethnic differences in the mental health problems and use of mental health care." Medical Care 43(8), pp. 775-784

Researchers analyzed data from the 2001-2003 National Surveys on Drug Use and Health, specifically the subsample of 134,875 adults who answered questions in the Adult Mental Health module. Findings indicate that more American Indian/Alaskan Natives and multiracial respondents than whites had at least one mental health symptom (26 and 30 percent vs. 20 percent, respectively) and more multiracial respondents had serious mental illness (10 vs. 6 percent). Blacks, Asians, Mexicans, and Central or South Americans had significantly lower rates compared to whites of at least one mental health symptom and serious mental illness. However, compared with Mexicans, Puerto Ricans had significantly higher rates of mental health problems.

American Indian/Alaskan Natives and multiracial respondents used mental health care at rates similar to those of whites, despite worse mental health status. Blacks, Asians, Mexicans, and other Hispanics used mental health care at significantly lower rates than whites, with less than 10 percent in each group reporting use of mental health care in the past year. Puerto Ricans and other Hispanics used mental health care services at higher rates than Mexicans (13 and 9 percent vs. 7 percent, respectively). American Indians and Alaskan Natives reported substantially higher rates of unmet need compared with whites (33 vs. 18 percent and 63 vs. 35 percent, respectively).

Reprints (AHRQ Publication No. 05-R064) are available from the AHRQ Clearinghouse.

Hepner, K.A., Brown, J.A., and Hays, R.D. (2005, December). "Comparison of mail and telephone in assessing patient experiences in receiving care from medical group practices." (AHRQ grant HS00924). Evaluation & The Health Professions 28(4), pp. 377-389.

This study compares mail and telephone responses to the medical groups survey from the Consumer Assessment of Health Plans Study (G-CAHPS) in a sample of 880 patients from 4 physician groups. Patients were randomly assigned to a survey mode, although in the end both survey modes produced similar results. The investigators obtained a total of 537 phone completes and 343 mail completes (a 54 percent response rate). There were no significant differences in internal consistency by mode. In addition, there was only one significant mode difference in item and composite means by mode of survey administration after adjustment for case-mix differences.

Janssen, W.J., Collard, H.R., Saint, S., and Weinberger, S.E. (2005, November). "A perfect storm." (AHRQ grant HS11540). New England Journal of Medicine 353(18), pp. 1956-1961.

This article discusses a clinical case in which the combination of scoliosis, a rigid spine, costovertebral joint contractures, and respiratory muscle weakness—perhaps worsened by respiratory infection—generated a "perfect storm" for hypercapnic respiratory failure in a 21-year-old male college student. Although the physician correctly deduced that the patient's hypoxemia was due to chronic hypoventilation, he did not identify the specific abnormality as rigid spine syndrome, which is rare. The authors caution that hypoventilation in a young adult is rare and should raise concern about congenital diseases. Congenital neuromuscular disease should be considered in all patients, but particularly those with severe scoliosis.

Kuhlthau, K., Ferris, T.G., Davis, R.B., and others (2005, November). "Pharmacy- and diagnosis-based risk adjustment for children with Medicaid." (AHRQ grant HS10152). Medical Care 43(11), pp. 1155-1159.

This study found that models with either pharmacy- or diagnosis-based risk adjustment improved the prediction of Medicaid child health expenditures compared to demographic models without risk adjustment. No single risk adjuster performed best in all situations. This suggests that optimal choices of risk adjuster may differ by purpose and content, note the authors. They used 1994-1995 Medicaid claims files for children who were not covered by managed care in three States, examining six risk adjustment methods: two pharmacy-based and four diagnosis-based. They compared the predictive accuracy of the methods for the whole sample and stratified by State and Medicaid enrollment category.

Luo, N., Johnson, J.A., Shaw, J.W., and others (2005, November). "Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and health utilities index." (AHRQ grant HS10243). Medical Care 43(11), pp. 1078-1086.

This study describes the self-reported health status of the general adult U.S. population using three multi-attribute preference-based measures—the EQ-5D, Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3). A total of 4,048 respondents completed all 3 questionnaires. Generally, younger, male, and Hispanic or black adults had better index scores than older, female adults and adults in other racial/ethnic categories. Index scores were also higher with higher educational attainment and household income. Although the three indexes appeared to be valid and demonstrated similarities, health status assessed by these measures is not exactly the same.

McCloskey, L.A., Lichter, E., Ganz, M.L., and others (2005, August. "Intimate partner violence and patient screening across medical specialties." (AHRQ grant HS11088). Academic Emergency Medicine 12, p. 712-722, 2005.

Researchers analyzed the responses of 2,465 women who completed written surveys about intimate partner violence (IPV) and health care screening for IPV. Among the women who responded to the survey, 14 percent had suffered IPV during the previous 12-month period, with 37 percent revealing a lifetime suffering from IPV. The highest rates of recent IPV were disclosed in the hospital-based addiction recovery units (36 percent) and in the EDs (17 percent).

Women between 18 and 23 years were at highest risk of being IPV victims. Also, women who were IPV victims were twice as likely to have an annual income less than $20,000 and nearly twice as likely to be unemployed than women who were not victims. Healthcare providers were more likely to inquire about IPV with low-income than middle- or high-income women, but were no more likely to ask about IPV among the youngest age group. Among women who did reveal being a victim of IPV to their health care provider, half reported receiving direct interventions or services as a result.

Murray, P.K., Love, T.E., Dawson, N.V., and others (2005, November). "Rehabilitation services after the implementation of the nursing home prospective payment system." (AHRQ grant HS13412). Medical Care 43(11), pp. 1109-1115.

The prospective payment system (PPS) for nursing homes was designed to curtail the rapid expansion of Medicare costs for skilled nursing care. This study found that following implementation of the PPS, patients had less cognitive impairment, more depression, and more family support. The amount of rehabilitation services declined the most in patients most likely to receive them before PPS and in stroke patients. In contrast, patients who in the pre-PPS period were in groups unlikely to receive therapy, were more likely to receive some type of rehabilitation service in the post-PPS period. The changes were most apparent in for-profit nursing homes.

Sawaya, G.F. (2005, December). "A 21-year-old woman with atypical squamous cells of undetermined significance." (AHRQ grant HS10856). Journal of the American Medical Association 294(17), pp. 2210-2218.

The author discusses the case of a 21-year-old woman with a history of abnormal Pap tests, which showed atypical squamous cells of undetermined significance. Current guidelines recommend that cervical cancer screening should not begin before the onset of vaginal intercourse and should be delayed for about 3 years, but begin no later than age 21 years. This is because screening before the 3-year period may result in an overdiagnosis of cervical lesions that will regress spontaneously, leading to inappropriate interventions that may do more harm than good. That was the case of this young woman, who had her first Pap test 4 months after beginning sexual intercourse, when she was 19 years old. Within her first 3 years of being screened, she had six cervical cytology tests, a colposcopy with a cervical biopsy, and two more cytology tests are planned within the coming year. So far, no cervical disease has been identified.

Stuart, B., Briesacher, B.A., Shea, D.G., and others (2005, July). "Riding the rollercoaster: The ups and downs in out-of-pocket spending under the standard Medicare drug benefit." Health Affairs 24(4), pp. 1022-1031.

Researchers analyzed data from the 1998-2000 Medicare Current Beneficiary Survey and the National Health Accounts from the Center for Medicare and Medicaid Services to examine out-of-pocket spending under the 2006 MMA Part D drug benefit. They estimated quarterly out-of-pocket drug spending from 2006 through 2008 for all beneficiaries and two subgroups dubbed "high spenders" (those with projected 2006 drug spending above the initial benefit limit of $2,250) and "catastrophic spenders" (projected 2006 drug spending above the catastrophic threshold of $5,100).

The researchers projected that, averaged over 3 years, potential Part D enrollees would pay 44 percent of total drug spending out of pocket. High spenders would pay about 67 percent out of pocket, and catastrophic spenders would pay about 51 percent. These out-of-pocket spending estimates do not include premiums, which are projected to be about $35 a month in 2006, $37 in 2007, and $41 in 2008.

Reprints (AHRQ Publication No. 05-R069) are available from the AHRQ Clearinghouse.

Zuvekas, S.H., Rupp, A.E., and Norquist, G.S. (2005, November). "The impacts of mental health parity and managed care in one large employer group: A reexamination." Health Affairs 24(6), pp. 1668-1671.

Numerous case studies demonstrate that managed behavioral health care organizations (MBHOs) reduce mental health specialty provider treatment costs, even when mental health benefits are expanded. Less clear is how access to mental health treatment changes in response to changes in coverage and the introduction of an MBHO carve-out. The authors of this paper reexamine a study which found that the number of people receiving mental health/substance abuse treatment increased by almost 50 percent after the introduction of mental health parity and an MBHO. Based on their use of multivariate panel data methods, they suggest that secular trends were largely responsible for this increase.

Reprints (AHRQ Publication No. 06-R016) are available from the AHRQ Clearinghouse.

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