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BackgroundPayers and policy makers across the international healthcare market are increasingly using publicly available summary measures to designate providers as "high-performing", but no consistently-applied approach exists to identifying high performers. This paper uses publicly available data to examine how different classification approaches influence which providers are designated as "high-performers".MethodsWe conducted a quantitative analysis of cross-sectional publicly-available performance data in the U.S. We used 2014 Minnesota Community Measurement data from 58 medical groups to classify performance across 4 domains: quality (two process measures of cancer screening and 2 composite measures of chronic disease management), total cost of care, access (a composite CAHPS measure), and patient experience (3 CAHPS measures). We classified medical groups based on performance using either relative thresholds or absolute values of performance on all included measures.ResultsUsing relative thresholds, none of the 58 medical groups achieved performance in the top 25% or 35% in all 4 performance domains. A relative threshold of 40% was needed before one group was classified as high-performing in all 4 domains. Using absolute threshold values, two medical groups were classified as high-performing across all 4 domains. In both approaches, designating "high performance" using fewer domains led to more groups designated as high-performers, though there was little to moderate concordance across identified "high-performing" groups.ConclusionsClassification of medical groups as high performing is sensitive to the domains of performance included, the classification approach, and choice of threshold. With increasing focus on achieving high performance in healthcare delivery, the absence of a consistently-applied approach to identify high performers impedes efforts to reliably compare, select and reward high-performing providers.

Background The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (ie, "stress burden") on cognitive function and clinically adjudicated cognitive outcomes among older Black American adults, and examines sleep as a mediator. Methods The sample included 204 Black adults (79% female; mean age = 64 years) from Pittsburgh, PA, USA. Stress burden comprised 3 self-reported stress and distress measures assessed in 2016: discrimination, psychological distress, and posttraumatic stress. Potential mediators included actigraphy-assessed sleep duration and efficiency from 2018. Cognitive battery and clinical adjudication in 2019 assessed cognitive function and clinically adjudicated outcomes. Causal mediation analysis estimated the direct effect between stress burden and cognitive outcomes, and indirect effects through sleep, after adjusting for sociodemographics and hypertension. Results Higher stress burden had a significant direct effect on lower executive functioning and visuospatial performance. However, there were no significant indirect effects (ie, mediation) by sleep disturbances on any domain of cognitive function assessed. Also, there were no significant direct or indirect effects on clinically adjudicated outcomes. Conclusions Multiple stressors often co-occur and may contribute to racial disparities in cognitive health. Findings suggest that higher stress burden had negative effects on functioning in executive and visuospatial domains in this community-based sample of older Black American adults. However, there was no evidence of mediation by sleep. Findings highlight the importance of continued work to identify modifiable pathways between stress burden and cognitive health disparities. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To examine characteristics of Medicare Advantage (MA) enrollees who use their plan's customer service to help plans understand how to better meet members' needs. STUDY DESIGN: National sample of 259,533 respondents to MA Consumer Assessment of Healthcare Providers and Systems survey enrolled in any of the 559 MA contracts in 2022. METHODS: We assessed the association between self-reported customer service use in the prior 6 months and enrollee demographic, coverage, health, and health care utilization characteristics. We used weighted linear regression models to test for bivariate and multivariate associations between customer service use and enrollee characteristics. RESULTS: Forty-two percent of MA enrollees reported using customer service in the prior 6 months. Use was 20 percentage points (PP) higher for those in poor vs excellent/very good general health, 13 PP higher for those in poor vs excellent/very good mental health, and 14 PP higher for those reporting 3 or more vs no chronic conditions. Those using customer service more often had lower educational attainment, had limited income and assets, preferred another language to English, and had greater health care utilization. CONCLUSIONS: MA customer service supports a less healthy, higher-need population with greater-than-average barriers to health care, and so should be designed and staffed to effectively serve medically complex, high-need patients. Commercial plan evidence suggests that continuity in customer service support for a member or a given issue may be helpful. Customer service is an important mechanism for improving quality and addressing health equity. [ABSTRACT FROM AUTHOR]

Census data are vital to health care research but must also protect respondents' confidentiality. The 2020 decennial Census employs a new Differential Privacy framework; this study examines its effect on the accuracy of an important tool for measuring health disparities, the Bayesian Improved Surname and Geocoding (BISG) algorithm, which uses Census Block Group data to estimate race and ethnicity when self-reported data are unavailable. Using self-reported race and ethnicity data as our standard, we compared the accuracy of BISG estimates calculated using the original 2010 Census counts to the accuracy of estimates calculated using 2010 data but with 2020 Differential Privacy in place. The Differential Privacy methodology slightly decreases BISG accuracy for American Indian and Alaska Native people but has little effect for other groups, suggesting that the methodology will not impede health disparities research that employs BISG and similar methods. [ABSTRACT FROM AUTHOR]

Background: Limitations in the quality of race‐and‐ethnicity information in Medicare's data systems constrain efforts to assess disparities in care among older Americans. Using demographic information from standardized patient assessments may be an efficient way to enhance the accuracy and completeness of race‐and‐ethnicity information in Medicare's data systems, but it is critical to first establish the accuracy of these data as they may be prone to inaccurate observer‐reported or third‐party‐based information. This study evaluates the accuracy of patient‐level race‐and‐ethnicity information included in the Outcome and Assessment Information Set (OASIS) submitted by home health agencies. Methods: We compared 2017–2022 OASIS‐D race‐and‐ethnicity data to gold‐standard self‐reported information from the Medicare Consumer Assessment of Healthcare Providers and Systems® survey in a matched sample of 304,804 people with Medicare coverage. We also compared OASIS data to indirect estimates of race‐and‐ethnicity generated using the Medicare Bayesian Improved Surname and Geocoding (MBISG) 2.1.1 method and to existing Centers for Medicare & Medicaid Services (CMS) administrative records. Results: Compared with existing CMS administrative data, OASIS data are far more accurate for Hispanic, Asian American and Native Hawaiian or other Pacific Islander, and White race‐and‐ethnicity; slightly less accurate for American Indian or Alaska Native race‐and‐ethnicity; and similarly accurate for Black race‐and‐ethnicity. However, MBISG 2.1.1 accuracy exceeds that of both OASIS and CMS administrative data for every racial‐and‐ethnic category. Patterns of inconsistent reporting of racial‐and‐ethnic information among people for whom there were multiple observations in the OASIS and Consumer Assessment of Healthcare Providers and Systems (CAHPS) datasets suggest that some of the inaccuracies in OASIS data may result from observation‐based reporting that lessens correspondence with self‐reported data. Conclusions: When health record data on race‐and‐ethnicity includes observer‐reported information, it can be less accurate than both true self‐report and a high‐performing imputation approach. Efforts are needed to encourage collection of true self‐reported data and explicit record‐level data on the source of race‐and‐ethnicity information. [ABSTRACT FROM AUTHOR]

RESEARCH OBJECTIVE:Care coordination among health care providers is essential for high-quality care and it is strongly associated with overall ratings of doctors. Care coordination may be especially important for sicker and chronically ill patients because of the multiple providers involved in their care. This study examines whether the association of care coordination with global ratings of one's personal doctor varies by number of chronic conditions and self-rated health. STUDY DESIGN:We used nationally representative Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data to evaluate care coordination, doctor communication, getting needed care, getting care quickly, count of 6 chronic conditions (angina, cancer, chronic obstructive pulmonary disease, diabetes, heart attack, stroke), self-rated general health (5-point scale, poor to excellent, scored linearly), and interactions among them as predictors of the CAHPS global rating of personal doctor (scored 0-100 with 100 being best possible personal doctor) using linear regression models. The analytic sample included 242,871 Medicare fee-for-service and managed care beneficiaries in 2013: 56% female; 14% 18-64, 47% 65-74, 27% 75-84, and 11% 85 and older; and 48% high school education or less. RESULTS:The CAHPS composites (of care coordination, doctor communication, getting needed care, and getting care quickly) and number of chronic conditions were significantly positively associated with ratings of personal doctor (P

BackgroundA decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach.MethodsProject JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement. We conducted a cluster-randomized trial including ten states (five campaign states and five non-campaign states) with 188 hospitals providing joint replacement to Medicare. We measured adherence to the evidence-based practices before and after the campaign using a survey of surgical staff and a difference-in-difference design with multivariable adjustment to compare adherence to each of the relevant practices and an all-or-none composite measure of the three new practices.ResultsIn the campaign states, there were statistically significant increases in adherence to the three new evidence-based practices promoted by the campaign. Compared to the non-campaign states, the relative increase in adherence to the three new practices in the campaign states ranged between 1.9 and 15.9 percentage points, but only one of these changes (pre-operative nasal screening for Staphylococcus aureus carriage and decolonization prior to surgery) was statistically significant (p

Following the publication of the original article [1], it was brought to our attention that the title contained an error: "The Institute for Healthcare Improvement's Project JOINTS" was incorrectly included as "the Institute for Health Improvement's Project JOINTS". The title has been corrected to read: "Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the IHI's Project JOINTS". The corrected title has been included in this erratum and updated in the original article.

BackgroundAsian Americans (hereafter "Asians") generally report worse experiences with care than non-Latino whites (hereafter "whites"), which may reflect differential use of response scales. Past studies indicate that Asians exhibit lower Extreme Response Tendency (ERT)-they less frequently use responses at extreme ends of the scale than whites.ObjectiveTo explore whether lower ERT is observed for Asians than whites in response to standardized vignettes depicting patient experiences of care and whether ERT might in part explain Asians reporting worse care than whites.ProcedureA representative US sample (n=575 Asian; n=505 white) was presented with 5 written vignettes describing doctor-patient encounters with differing levels of physician responsiveness. Respondents evaluated the encounters using modified CAHPS communication questions.ResultsCase-mix-adjusted repeated-measures multivariate models show that Asians provided more positive responses than whites to several vignettes with less-responsive physicians but less positive responses than whites for the vignette with the most physician responsiveness (P

New analysis of responses to the National Transgender Discrimination Survey (NTDS) shows that transgender respondents who experienced rejection by family and friends, discrimination, victimization, or violence have a higher risk of attempting suicide. 78 percent of survey respondents who suffered physical or sexual violence at school reported suicide attempts, as did 65 percent of respondents who experienced violence at work.The study suggests that several minority stressors – negative experiences related to anti-transgender bias – may contribute to elevated prevalence of suicide attempts among transgender people, such as experiences of harassment, family rejection, housing instability, and discrimination in health care. Over half of those who experienced harassment or bullying in schools reported lifetime suicide attempts, as did 57 percent of those who reported that their family chose not to speak/spend time with them.  High prevalence of suicide attempts was also found among those who had ever experienced homelessness (69%) and those who reported a doctor or healthcare provider refused to treat them (60%).The study utilized data collected through the National Transgender Discrimination Survey (NTDS), which was conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force. 6,456 transgender and gender non-conforming people in the United States reported on their experiences of discrimination and abuse at work, at home, in school, and in the public sphere, amassing the largest transgender survey sample to date.