202 results on '"Schneider EC"'
Search Results
2. Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the Institute for Health Improvement's Project JOINTS
- Author
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Schneider, EC, Sorbero, ME, Haas, A, Ridgely, MS, Khodyakov, D, Setodji, CM, Parry, G, Huang, SS, Yokoe, DS, and Goldmann, D
- Published
- 2017
3. PCV9 Study of Hypertensive Prescribing Practices
- Author
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Schulman, KA, primary, Mehta, SS, additional, Gersh, BJ, additional, Schneider, EC, additional, and Wilcox, C, additional
- Published
- 1998
- Full Text
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4. Can we rely on patients' reports of adverse events?
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Zhu J, Stuver SO, Epstein AM, Schneider EC, Weissman JS, and Weingart SN
- Published
- 2011
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5. Hospitalized patients' participation and its impact on quality of care and patient safety.
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Weingart SN, Zhu J, Chiappetta L, Stuver SO, Schneider EC, Epstein AM, David-Kasdan JA, Annas CL, Fowler FJ Jr, Weissman JS, Weingart, Saul N, Zhu, Junya, Chiappetta, Laurel, Stuver, Sherri O, Schneider, Eric C, Epstein, Arnold M, David-Kasdan, Jo Ann, Annas, Catherine L, Fowler, Floyd J Jr, and Weissman, Joel S
- Abstract
Objective: To understand the extent to which hospitalized patients participate in their care, and the association of patient participation with quality of care and patient safety.Design: Random sample telephone survey and medical record review.Setting: US acute care hospitals in 2003.Participants: A total of 2025 recently hospitalized adults.Main Outcome Measures: Hospitalized patients reported participation in their own care, assessments of overall quality of care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review.Results: Of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of >4 activities) was strongly associated with patients' favorable ratings of the hospital quality of care (adjusted OR: 5.46, 95% CI: 4.15-7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR = 0.49, 0.31-0.78).Conclusions: Most hospitalized patients participated in some aspects of their care. Participation was strongly associated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event. [ABSTRACT FROM AUTHOR]- Published
- 2011
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6. Reliability of medical group and physician performance measurement in the primary care setting.
- Author
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Sequist TD, Schneider EC, Li A, Rogers WH, and Safran DG
- Published
- 2011
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7. American Society of Clinical Oncology/National Comprehensive Cancer Network quality measures.
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Desch CE, McNiff KK, Schneider EC, Schrag D, McClure J, Lepisto E, Donaldson MS, Kahn KL, Weeks JC, Ko CY, Stewart AK, and Edge SB
- Published
- 2008
8. The impact of pay-for-performance on health care quality in Massachusetts, 2001-3: few of these early P4P contracts were associated with greater quality improvement than was occurring in practices without such contracts.
- Author
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Pearson SD, Schneider EC, Kleinman KP, Cotlin KL, and Singer JA
- Published
- 2008
- Full Text
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9. Assessment of the scientific soundness of clinical performance measures: a field test of the National Committee for Quality Assurance's Colorectal Cancer Screening Measure.
- Author
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Schneider EC, Nadel MR, Zaslavsky AM, and McGlynn EA
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- 2008
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10. Patient centered experiences in breast cancer: predicting long-term adherence to tamoxifen use.
- Author
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Kahn KL, Schneider EC, Malin JL, Adams JL, and Epstein AM
- Published
- 2007
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11. Use of high-cost operative procedures by Medicare beneficiaries enrolled in for-profit and not-for-profit health plans.
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Schneider EC, Zaslavsky AM, and Epstein AM
- Published
- 2004
12. Race and gender disparities in rates of cardiac revascularization: do they reflect appropriate use of procedures or problems in quality of care?
- Author
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Epstein AM, Weissman JS, Schneider EC, Gatsonis C, Leape LL, and Piana RN
- Abstract
BACKGROUND: Numerous studies have documented substantial differences by race and gender in the use of coronary artery bypass graft surgery and percutaneous coronary angioplasty. However, few studies have examined whether these differences reflect problems in quality of care. METHOD: We selected a random sample stratified by gender, race, and income of 5026 Medicare beneficiaries aged 65 to 75 who underwent inpatient coronary angiography during 1991 to 1992 in 1 of 5 states. We compared the frequency of 2 problems in quality by race and gender: underuse or the failure to receive a clinically indicated revascularization procedure and receipt of revascularization when it was not clinically indicated. We used 2 independent sets of criteria developed by the RAND Corporation and the American College of Cardiology/American Hospital Association (ACC/AHA). We also examined survival of the cohort through March 31, 1994. RESULTS: Revascularization procedures were clinically indicated more frequently among whites than blacks and among men than women. Failure to receive revascularization when it was indicated was more common among blacks than among whites (40% vs. 23-24%, depending on the criteria, both P<0.001) but similar among men and women (25% vs. 22-24%, P>0.05). Racial disparities remained similar after adjusting for patient and hospital characteristics. Among patients rated inappropriate, use of procedures was greater for whites than blacks using RAND criteria (10.5% vs. 5.8%, P<0.01) and greater for men than for women (14.2% vs. 5.3% by RAND criteria, P=0.001; 8.2% vs. 4.0%% by ACC/AHA criteria, P=0.04). After multivariate adjustment, the disparities for race and gender remained similar and were statistically significant using RAND criteria. Mortality rates tended to validate our appropriateness criteria for underuse. CONCLUSIONS: Racial differences in procedure use reflect higher rates of clinical appropriateness among whites, greater underuse among blacks, and more frequent revascularization when it was not clinically indicated among whites. Underuse is associated with higher mortality. In contrast, men had higher rates of clinical appropriateness and were more likely to receive revascularization when it was not clinically indicated. There was no evidence of greater underuse among women. [ABSTRACT FROM AUTHOR]
- Published
- 2003
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13. Racial disparity in influenza vaccination: does managed care narrow the gap between African Americans and whites?
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Schneider EC, Cleary PD, Zaslavsky AM, Epstein AM, Schneider, E C, Cleary, P D, Zaslavsky, A M, and Epstein, A M
- Abstract
Context: Substantial racial disparities exist in use of some health services. Whether managed care could reduce racial disparities in the use of preventive services is not known.Objective: To determine whether the magnitude of racial disparity in influenza vaccination is smaller among managed care enrollees than among those with fee-for-service insurance.Design, Setting, and Participants: The 1996 Medicare Current Beneficiary Survey of a US cohort of 13 674 African American and white Medicare beneficiaries with managed care and fee-for-service insurance.Main Outcome Measures: Percentage of respondents (adjusted for sociodemographic characteristics, clinical comorbid conditions, and care-seeking attitudes) who received influenza vaccination and magnitude of racial disparity in influenza vaccination, compared among those with managed care and fee-for-service insurance.Results: Eight percent of the beneficiaries were African American and 11% were enrolled in managed care. Overall, 65.8% received influenza vaccination. Whites were substantially more likely to be vaccinated than African Americans (67.7% vs 46.1%; absolute disparity, 21.6%; 95% confidence interval [CI], 18.2%-25.0%). Managed care enrollees were more likely than those with fee-for-service insurance to receive influenza vaccination (71.2% vs 65.4%; difference, 5.8%; 95% CI, 3.6%-8.3%). The adjusted racial disparity in fee-for-service was 24.9% (95% CI, 19.6%-30.1%) and in managed care was 18.6% (95% CI, 9.8%-27.4%). These adjusted racial disparities were both statistically significant, but the absolute percentage point difference in racial disparity between the 2 insurance groups (6.3%; 95% CI, -4.6% to 17.2%) was not.Conclusion: Managed care is associated with higher rates of influenza vaccination for both whites and African Americans, but racial disparity in vaccination is not reduced in managed care. Our results suggest that additional efforts are needed to adequately address this disparity. [ABSTRACT FROM AUTHOR]- Published
- 2001
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14. Impact of sociodemographic case mix on the HEDIS measures of health plan quality.
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Zaslavsky AM, Hochheimer JN, Schneider EC, Cleary PD, Seidman JJ, McGlynn EA, Thompson JW, Sennett C, Epstein AM, Zaslavsky, A M, Hochheimer, J N, Schneider, E C, Cleary, P D, Seidman, J J, McGlynn, E A, Thompson, J W, Sennett, C, and Epstein, A M
- Published
- 2000
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15. Observations on reproduction, mortality, and behaviour in a small, free-living population of wild rabbits
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Myers, K, primary and Schneider, EC, additional
- Published
- 1964
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16. Is the type of Medicare insurance associated with colorectal cancer screening prevalence and selection of screening strategy?
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Schneider EC, Rosenthal M, Gatsonis CG, Zheng J, and Epstein AM
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- 2008
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17. For-profit health plans.
- Author
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Schaefer S, Schneider EC, Zaslavsky A, and Epstein A
- Published
- 2004
18. PCV9Study of Hypertensive Prescribing Practices
- Author
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Schulman, KA, Mehta, SS, Gersh, BJ, Schneider, EC, and Wilcox, C
- Abstract
Fifty million people in the US have hypertension. The JNC-V guidelines provide treatment recommendations for hypertension. These guidelines promote initiating therapy with diuretics and beta blockers since these agents have been shown to reduce hypertension-related morbidity and mortality.OBJECTIVES: To survey primary care physicians' antihypertensive prescribing practies, their perceptions about antihypertensive medication cost and safety and the perceived impact of managed care. METHODS: A direct mail survey was sent to a national random sample of 500 office-based, primary care internists, family practitioners, and general practitioners. RESULTS: Seventy-two percent of physicians reported being aware of the JNC-V guidelines. Younger physicians claimed to be more aware of and more likely to follow JNC-V guidelines than older physicians. Only 25% of physicians reported initiating treatment at systolic blood pressures greater than 140 mm Hg as recommended by the JNC-V guidelines. Diuretics were selected by 36% of physicians, angiotensin-converting enzyme (ACE) inhibitors by 35%, beta blockers by 16%, and calcium channel blockers (CCBs) by 7% for initial antihypertensive treatment. Up to 27% of physicians admitted not knowing the cost of specific medications. Approximately half of physicians reported that they and their patients were more concerned about medication cost and safety today than 18 months ago. A greater number of younger physicians than older physicians reported that managed care formularies infringed upon their prescribing practices. CONCLUSIONS: Antihypertensive prescribing patterns are inconsistent with JNC-V guidelines. Actual practice may deviate even more from these guidelines than reported in this survey. Also, primary care physicians perceive that managed care is increasingly affecting their prescribing practices.
- Published
- 1998
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19. Trends in the quality of care and racial disparities in Medicare managed care.
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Trivedi AN, Zaslavsky AM, Schneider EC, and Ayanian JZ
- Published
- 2005
20. Class, race, ethnicity and information needs in post-treatment cancer patients.
- Author
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Galarce EM, Ramanadhan S, Weeks J, Schneider EC, Gray SW, and Viswanath K
- Abstract
OBJECTIVE: Health information-seeking behaviors (HISBs) are associated with active participation in cancer care decisions which, in turn, may positively impact health outcomes. The goal of this study was to develop a taxonomy of topics for which post-treatment cancer patients sought information, and to explore HISB patterns by sociodemographic factors and cancer type. METHODS: We examined how health information seeking is associated with social determinants in a survey of 521 post-treatment cancer patients. RESULTS: Four major topics of interest were found: disease/treatment, self-care management, health services, and work/finance. Assessment of the relationship between social determinants and these four topics showed associations for (1) HISBs on disease/treatment topics decreased with age and increased with education; (2) HISBs on self-care management increased with education and varied by cancer type; (3) HISBs on health services increased with education; and (4) HISBs on work/finance decreased with age and wealth, but increased with debt. CONCLUSION: These results demonstrate one pathway through which social determinants may drive communication inequalities, which may result in increased disparities in health outcomes. PRACTICE IMPLICATIONS: Further exploration of the relationship between social determinants and information-seeking among post-treatment cancer patients may contribute to the development of strategies to reduce health disparities. [ABSTRACT FROM AUTHOR]
- Published
- 2011
21. Speaking truth about power: Are underpowered trials undercutting evaluation of new care models?
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Davis AC, Adams JL, McGlynn EA, and Schneider EC
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- Data Interpretation, Statistical, Clinical Trials as Topic
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- 2024
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22. Abnormal Lymphatic Sphingosine-1-Phosphate Signaling Aggravates Lymphatic Dysfunction and Tissue Inflammation.
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Kim D, Tian W, Wu TT, Xiang M, Vinh R, Chang JL, Gu S, Lee S, Zhu Y, Guan T, Schneider EC, Bao E, Dixon JB, Kao P, Pan J, Rockson SG, Jiang X, and Nicolls MR
- Subjects
- Humans, Mice, Animals, Signal Transduction, Inflammation pathology, P-Selectin, Lymphedema pathology
- Abstract
Background: Lymphedema is a global health problem with no effective drug treatment. Enhanced T-cell immunity and abnormal lymphatic endothelial cell (LEC) signaling are promising therapeutic targets for this condition. Sphingosine-1-phosphate (S1P) mediates a key signaling pathway required for normal LEC function, and altered S1P signaling in LECs could lead to lymphatic disease and pathogenic T-cell activation. Characterizing this biology is relevant for developing much needed therapies., Methods: Human and mouse lymphedema was studied. Lymphedema was induced in mice by surgically ligating the tail lymphatics. Lymphedematous dermal tissue was assessed for S1P signaling. To verify the role of altered S1P signaling effects in lymphatic cells, LEC-specific S1pr1 -deficient ( S1pr1
LECKO ) mice were generated. Disease progression was quantified by tail-volumetric and -histopathologic measurements over time. LECs from mice and humans, with S1P signaling inhibition, were then cocultured with CD4 T cells, followed by an analysis of CD4 T-cell activation and pathway signaling. Last, animals were treated with a monoclonal antibody specific to P-selectin to assess its efficacy in reducing lymphedema and T-cell activation., Results: Human and experimental lymphedema tissues exhibited decreased LEC S1P signaling through S1P receptor 1 (S1PR1). LEC S1pr1 loss-of-function exacerbated lymphatic vascular insufficiency, tail swelling, and increased CD4 T-cell infiltration in mouse lymphedema. LECs, isolated from S1pr1LECKO mice and cocultured with CD4 T cells, resulted in augmented lymphocyte differentiation. Inhibiting S1PR1 signaling in human dermal LECs promoted T-helper type 1 and 2 (Th1 and Th2) cell differentiation through direct cell contact with lymphocytes. Human dermal LECs with dampened S1P signaling exhibited enhanced P-selectin, an important cell adhesion molecule expressed on activated vascular cells. In vitro, P-selectin blockade reduced the activation and differentiation of Th cells cocultured with shS1PR1 -treated human dermal LECs. P-selectin-directed antibody treatment improved tail swelling and reduced Th1/Th2 immune responses in mouse lymphedema., Conclusions: This study suggests that reduction of the LEC S1P signaling aggravates lymphedema by enhancing LEC adhesion and amplifying pathogenic CD4 T-cell responses. P-selectin inhibitors are suggested as a possible treatment for this pervasive condition., Competing Interests: Disclosures None.- Published
- 2023
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23. Artificial Intelligence-Driven Morphology-Based Enrichment of Malignant Cells from Body Fluid.
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Mavropoulos A, Johnson C, Lu V, Nieto J, Schneider EC, Saini K, Phelan ML, Hsie LX, Wang MJ, Cruz J, Mei J, Kim JJ, Lian Z, Li N, Boutet SC, Wong-Thai AY, Yu W, Lu QY, Kim T, Geng Y, Masaeli MM, Lee TD, and Rao J
- Subjects
- Humans, Artificial Intelligence, Pleural Effusion, Malignant diagnosis, Pleural Effusion, Malignant pathology, Body Fluids, Carcinoma
- Abstract
Cell morphology is a fundamental feature used to evaluate patient specimens in pathologic analysis. However, traditional cytopathology analysis of patient effusion samples is limited by low tumor cell abundance coupled with the high background of nonmalignant cells, restricting the ability of downstream molecular and functional analyses to identify actionable therapeutic targets. We applied the Deepcell platform that combines microfluidic sorting, brightfield imaging, and real-time deep learning interpretations based on multidimensional morphology to enrich carcinoma cells from malignant effusions without cell staining or labels. Carcinoma cell enrichment was validated with whole genome sequencing and targeted mutation analysis, which showed a higher sensitivity for detection of tumor fractions and critical somatic variant mutations that were initially at low levels or undetectable in presort patient samples. Our study demonstrates the feasibility and added value of supplementing traditional morphology-based cytology with deep learning, multidimensional morphology analysis, and microfluidic sorting., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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24. Abnormal lymphatic S1P signaling aggravates lymphatic dysfunction and tissue inflammation.
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Kim D, Tian W, Wu TT, Xiang M, Vinh R, Chang J, Gu S, Lee S, Zhu Y, Guan T, Schneider EC, Bao E, Dixon JB, Kao P, Pan J, Rockson SG, Jiang X, and Nicolls MR
- Abstract
Background: Lymphedema is a global health problem with no effective drug treatment. Enhanced T cell immunity and abnormal lymphatic endothelial cell (LEC) signaling are promising therapeutic targets for this condition. Sphingosine-1-phosphate (S1P) mediates a key signaling pathway required for normal LEC function, and altered S1P signaling in LECs could lead to lymphatic disease and pathogenic T cell activation. Characterizing this biology is relevant for developing much-needed therapies., Methods: Human and mouse lymphedema was studied. Lymphedema was induced in mice by surgically ligating the tail lymphatics. Lymphedematous dermal tissue was assessed for S1P signaling. To verify the role of altered S1P signaling effects in lymphatic cells, LEC-specific S1pr1 -deficient ( S1pr1
LECKO ) mice were generated. Disease progression was quantified by tail-volumetric and -histopathological measurements over time. LECs from mice and humans, with S1P signaling inhibition, were then co-cultured with CD4 T cells, followed by an analysis of CD4 T cell activation and pathway signaling. Finally, animals were treated with a monoclonal antibody specific to P-selectin to assess its efficacy in reducing lymphedema and T cell activation., Results: Human and experimental lymphedema tissues exhibited decreased LEC S1P signaling through S1PR1. LEC S1pr1 loss-of-function exacerbated lymphatic vascular insufficiency, tail swelling, and increased CD4 T cell infiltration in mouse lymphedema. LECs, isolated from S1pr1LECKO mice and co-cultured with CD4 T cells, resulted in augmented lymphocyte differentiation. Inhibiting S1PR1 signaling in human dermal LECs (HDLECs) promoted T helper type 1 and 2 (Th1 and Th2) cell differentiation through direct cell contact with lymphocytes. HDLECs with dampened S1P signaling exhibited enhanced P-selectin, an important cell adhesion molecule expressed on activated vascular cells. In vitro , P-selectin blockade reduced the activation and differentiation of Th cells co-cultured with sh S1PR1 -treated HDLECs. P-selectin-directed antibody treatment improved tail swelling and reduced Th1/Th2 immune responses in mouse lymphedema., Conclusion: This study suggests that reduction of the LEC S1P signaling aggravates lymphedema by enhancing LEC adhesion and amplifying pathogenic CD4 T cell responses. P-selectin inhibitors are suggested as a possible treatment for this pervasive condition., Clinical Perspective: What is New?: Lymphatic-specific S1pr1 deletion exacerbates lymphatic vessel malfunction and Th1/Th2 immune responses during lymphedema pathogenesis. S1pr1 -deficient LECs directly induce Th1/Th2 cell differentiation and decrease anti-inflammatory Treg populations. Peripheral dermal LECs affect CD4 T cell immune responses through direct cell contact.LEC P-selectin, regulated by S1PR1 signaling, affects CD4 T cell activation and differentiation.P-selectin blockade improves lymphedema tail swelling and decreases Th1/Th2 population in the diseased skin. What Are the Clinical Implications?: S1P/S1PR1 signaling in LECs regulates inflammation in lymphedema tissue.S1PR1 expression levels on LECs may be a useful biomarker for assessing predisposition to lymphatic disease, such as at-risk women undergoing mastectomyP-selectin Inhibitors may be effective for certain forms of lymphedema.- Published
- 2023
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25. Rural disparities in the quality of clinical care are notable and larger for males.
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MacCarthy S, Elliott MN, Martino SC, Klein DJ, Haviland AM, Weech-Maldonado R, Dembosky JW, Tamayo L, Gaillot S, and Schneider EC
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- Aged, Male, Female, Humans, United States, Medicare, Hospitalization, Rural Population, Urban Population, Pulmonary Disease, Chronic Obstructive, Diabetes Mellitus
- Abstract
Purpose: To investigate whether rural-urban differences in quality of care for Medicare Advantage (MA) enrollees vary between females and males., Methods: Data for this study came from the 2019 Healthcare Effectiveness Data and Information Set. Linear regression was used to investigate urban-rural differences in individual MA enrollee scores on 34 clinical care measures grouped into 7 categories, and how those differences varied by sex (through evaluation of statistical interactions)., Findings: Across all 7 categories of measures, scores for rural residents were worse than scores for urban residents. For 4 categories-care for patients with (suspected) chronic obstructive pulmonary disease, avoiding prescription misuse, behavioral health, and diabetes care-the average difference across measures in the category was greater than 3 percentage points. Across all 34 measures, there were 15 statistically significant rural-by-sex interactions that exceeded 1 percentage point. In 11 of those cases, the deficit associated with living in a rural area was greater for males than for females. In 3 cases, the deficit associated with living in a rural area was larger for females than for males. In 1 case involving Follow-up After Hospitalization for Mental Illness, rural residents had an advantage, and it was larger for males than for females., Conclusions: Interventions may help address patient- (eg, health literacy and patient activation), provider- (eg, workforce recruitment and retention), and structural-level issues contributing to these disparities, especially for rural males., (© 2022 RAND Corporation and The Authors. The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)
- Published
- 2023
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26. Programs and Policies to Prevent Falls in North Carolina.
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Schneider EC, Bailey E, and Bou-Saada I
- Abstract
Competing Interests: Disclosure of interests: E.S. and I.B-S. serve on the NCIOM Task Force on Healthy Aging. No further interests were disclosed.
- Published
- 2023
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27. Popular… to a Point: The Enduring Political Challenges of the Public Option.
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McIntyre A, Blendon RJ, Benson JM, Findling MG, and Schneider EC
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- Aged, Humans, United States, Patient Protection and Affordable Care Act, Medicare, Pandemics, Politics, Health Care Reform, COVID-19 epidemiology
- Abstract
Policy Points A decade after failing to make it into the Affordable Care Act, the public option reemerged as a health reform goal at both the national and state levels, with polls reporting strong, bipartisan support. A 2020 poll that probed both support for one public option approach (Medicare "buy-in") and attitudes toward government suggests that differences in these attitudes could plague reform advocates' efforts. Although the COVID-19 pandemic viscerally highlighted the need for a more coherent health care system-including universal coverage-other recent evolutions in the broader US political context could undermine reform., (© 2023 Milbank Memorial Fund.)
- Published
- 2023
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28. The distillation method: A novel approach for analyzing randomized trials when exposure to the intervention is diluted.
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Adams JL, Davis AC, Schneider EC, Hull MM, and McGlynn EA
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- Humans, Randomized Controlled Trials as Topic, Health Services, Research Design, Distillation, Emergency Service, Hospital
- Abstract
Objective: To introduce a novel analytical approach for randomized controlled trials that are underpowered because of low participant enrollment or engagement., Data Sources: Reanalysis of data for 805 patients randomized as part of a pilot complex care intervention in 2015-2016 in a large delivery system. In the pilot randomized trial, only 64.6% of patients assigned to the intervention group participated., Study Design: A case study and simulation. The "Distillation Method" capitalizes on the frequently observed correlation between the probability of subjects' participation or engagement in the intervention and the magnitude of benefit they experience. The novel method involves three stages: first, it uses baseline covariates to generate predicted probabilities of participation. Next, these are used to produce nested subsamples of the randomized intervention and control groups that are more concentrated with subjects who were likely to participate/engage. Finally, for the outcomes of interest, standard statistical methods are used to re-evaluate intervention effectiveness in these concentrated subsets., Data Extraction Methods: We assembled secondary data on patients who were randomized to the pilot intervention for one year prior to randomization and two follow-up years. Data included program enrollment status, membership data, demographics, utilization, costs, and clinical data., Principal Findings: Using baseline covariates only, Generalized Boosted Regression Models predicting program enrollment performed well (AUC 0.884). We then distilled the full randomized sample to increasing levels of concentration and reanalyzed program outcomes. We found statistically significant differences in outpatient utilization and emergency department utilization (both follow-up years), and in total costs (follow-up year two only) at select levels of population concentration., Conclusions: By offering an internally valid analytic framework, the Distillation Method can increase the power to detect effects by redefining the estimand to subpopulations with higher enrollment probabilities and stronger average treatment effects while maintaining the original randomization., (© 2022 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)
- Published
- 2022
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29. Return on Investment of the COVID-19 Vaccination Campaign in New York City.
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Sah P, Vilches TN, Moghadas SM, Pandey A, Gondi S, Schneider EC, Singer J, Chokshi DA, and Galvani AP
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- Humans, New York City epidemiology, Immunization Programs, Investments, COVID-19 Vaccines therapeutic use, COVID-19 epidemiology, COVID-19 prevention & control
- Abstract
Importance: New York City, an early epicenter of the pandemic, invested heavily in its COVID-19 vaccination campaign to mitigate the burden of disease outbreaks. Understanding the return on investment (ROI) of this campaign would provide insights into vaccination programs to curb future COVID-19 outbreaks., Objective: To estimate the ROI of the New York City COVID-19 vaccination campaign by estimating the tangible direct and indirect costs from a societal perspective., Design, Setting, and Participants: This decision analytical model of disease transmission was calibrated to confirmed and probable cases of COVID-19 in New York City between December 14, 2020, and January 31, 2022. This simulation model was validated with observed patterns of reported hospitalizations and deaths during the same period., Exposures: An agent-based counterfactual scenario without vaccination was simulated using the calibrated model., Main Outcomes and Measures: Costs of health care and deaths were estimated in the actual pandemic trajectory with vaccination and in the counterfactual scenario without vaccination. The savings achieved by vaccination, which were associated with fewer outpatient visits, emergency department visits, emergency medical services, hospitalizations, and intensive care unit admissions, were also estimated. The value of a statistical life (VSL) lost due to COVID-19 death and the productivity loss from illness were accounted for in calculating the ROI., Results: During the study period, the vaccination campaign averted an estimated $27.96 (95% credible interval [CrI], $26.19-$29.84) billion in health care expenditures and 315 724 (95% CrI, 292 143-340 420) potential years of life lost, averting VSL loss of $26.27 (95% CrI, $24.39-$28.21) billion. The estimated net savings attributable to vaccination were $51.77 (95% CrI, $48.50-$55.85) billion. Every $1 invested in vaccination yielded estimated savings of $10.19 (95% CrI, $9.39-$10.87) in direct and indirect costs of health outcomes that would have been incurred without vaccination., Conclusions and Relevance: Results of this modeling study showed an association of the New York City COVID-19 vaccination campaign with reduction in severe outcomes and avoidance of substantial economic losses. This significant ROI supports continued investment in improving vaccine uptake during the ongoing pandemic.
- Published
- 2022
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30. Estimating the impact of vaccination on reducing COVID-19 burden in the United States: December 2020 to March 2022.
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Sah P, Vilches TN, Pandey A, Schneider EC, Moghadas SM, and Galvani AP
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- Humans, United States epidemiology, Vaccination, COVID-19 prevention & control, Influenza, Human
- Abstract
Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests.
- Published
- 2022
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31. Innovation Centers in Health Care Delivery Systems: Structures for Success.
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Bhattacharyya O, Shapiro J, and Schneider EC
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- Delivery of Health Care, Humans, Organizational Innovation, SARS-CoV-2, COVID-19, Pandemics
- Abstract
The need to support innovation in health care delivery was prompted by payment reforms and access to digital tools and has been accelerated by the shift to virtual care as part of the COVID-19 pandemic response. Prior to the pandemic, a growing number of health systems set up innovation centers to focus on creating new services and exploring new business models relevant to value-based care. This is distinct from process improvement or implementation science, and often needs a different set of incentives to succeed within a large organization. We used a national survey to identify a diverse sample of innovation centers, and interviewed leaders to describe their aims, organizational structures, and activities. They all aim to improve patient outcomes and experience while reducing costs, but their strategic focus may differ. The centers also vary in their reporting structure, how they build internal capacity, and how they measure success. We highlight the range of strategies through examples of projects that improve quality, reduce costs, and generate new revenue. While the optimal forms and impact of innovation centers are still emerging, the fiscal pressures and the rapid uptake of digital technologies present opportunities for the redesign of health services in the postpandemic era. The experiences of these centers illustrate a set of approaches to increase any organization's capacity for innovation., (©Onil Bhattacharyya, Justin Shapiro, Eric C Schneider. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 10.02.2022.)
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- 2022
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32. COVID-19 hospitalizations and deaths averted under an accelerated vaccination program in northeastern and southern regions of the USA.
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Vilches TN, Sah P, Moghadas SM, Shoukat A, Fitzpatrick MC, Hotez PJ, Schneider EC, and Galvani AP
- Abstract
Background: The fourth wave of COVID-19 pandemic peaked in the US at 160,000 daily cases, concentrated primarily in southern states. As the Delta variant has continued to spread, we evaluated the impact of accelerated vaccination on reducing hospitalization and deaths across northeastern and southern regions of the US census divisions., Methods: We used an age-stratified agent-based model of COVID-19 to simulate outbreaks in all states within two U.S. regions. The model was calibrated using reported incidence in each state from October 1, 2020 to August 31, 2021, and parameterized with characteristics of the circulating SARS-CoV-2 variants and state-specific daily vaccination rate. We then projected the number of infections, hospitalizations, and deaths that would be averted between September 2021 and the end of March 2022 if the states increased their daily vaccination rate by 20 or 50% compared to maintaining the status quo pace observed during August 2021., Findings: A 50% increase in daily vaccine doses administered to previously unvaccinated individuals is projected to prevent a total of 30,727 hospitalizations and 11,937 deaths in the two regions between September 2021 and the end of March 2022. Southern states were projected to have a higher weighted average number of hospitalizations averted (18.8) and lives saved (8.3) per 100,000 population, compared to the weighted average of hospitalizations (12.4) and deaths (2.7) averted in northeastern states. On a per capita basis, a 50% increase in daily vaccinations is expected to avert the most hospitalizations in Kentucky (56.7 hospitalizations per 100,000 averted with 95% CrI: 45.56 - 69.9) and prevent the most deaths in Mississippi, (22.1 deaths per 100,000 population prevented with 95% CrI: 18.0 - 26.9)., Interpretation: Accelerating progress to population-level immunity by raising the daily pace of vaccination would prevent substantial hospitalizations and deaths in the US, even in those states that have passed a Delta-driven peak in infections., Funding: This study was supported by The Commonwealth Fund. SMM acknowledges the support from the Canadian Institutes of Health Research [OV4 - 170643, COVID-19 Rapid Research] and the Natural Sciences and Engineering Research Council of Canada, Emerging Infectious Disease Modelling, MfPH grant. MCF acknowledges support from the National Institutes of Health (5 K01 AI141576)., Competing Interests: None, (© 2021 The Authors.)
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- 2022
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33. Underserved population acceptance of combination influenza-COVID-19 booster vaccines.
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Lennon RP, Block R Jr, Schneider EC, Zephrin L, and Shah A
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- Adult, COVID-19 Vaccines, Cross-Sectional Studies, Female, Humans, SARS-CoV-2, Vaccination, Vulnerable Populations, COVID-19, Influenza Vaccines, Influenza, Human prevention & control
- Abstract
Recent data indicates increasing hesitancy towards both COVID-19 and influenza vaccination. We studied attitudes towards COVID-19 booster, influenza, and combination influenza-COVID-19 booster vaccines in a nationally representative sample of US adults between May and June 2021 (n = 12,887). We used pre-qualification quotes to ensure adequate sample sizes for minority populations. Overall vaccine acceptance was 45% for a COVID-19 booster alone, 58% for an influenza vaccine alone, and 50% for a combination vaccine. Logistic regression showed lower acceptance among female, Black/African American, Native American/American Indian, and rural respondents. Higher acceptance was found among those with college and post-graduate degrees. Despite these differences, our results suggest that a combination vaccine may provide a convenient method of dual vaccination that may increase COVID-19 vaccination coverage., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)
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- 2022
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34. Lives saved and hospitalizations averted by COVID-19 vaccination in New York City: a modeling study.
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Shoukat A, Vilches TN, Moghadas SM, Sah P, Schneider EC, Shaff J, Ternier A, Chokshi DA, and Galvani AP
- Abstract
Background: Following the start of COVID-19 vaccination in New York City (NYC), cases have declined over 10-fold from the outbreak peak in January 2020, despite the emergence of highly transmissible variants. We evaluated the impact of NYC's vaccination campaign on saving lives as well as averting hospitalizations and cases., Methods: We used an age-stratified agent-based model of COVID-19 to include transmission dynamics of Alpha, Gamma, Delta and Iota variants as identified in NYC. The model was calibrated and fitted to reported incidence in NYC, accounting for the relative transmissibility of each variant and vaccination rollout data. We simulated COVID-19 outbreak in NYC under the counterfactual scenario of no vaccination and compared the resulting disease burden with the number of cases, hospitalizations and deaths reported under the actual pace of vaccination., Findings: We found that without vaccination, there would have been a spring-wave of COVID-19 in NYC due to the spread of Alpha and Delta variants. The COVID-19 vaccination campaign in NYC prevented such a wave, and averted 290,467 (95% CrI: 232,551 - 342,664) cases, 48,076 (95% CrI: 42,264 - 53,301) hospitalizations, and 8,508 (95% CrI: 7,374 - 9,543) deaths from December 14, 2020 to July 15, 2021., Interpretation: Our study demonstrates that the vaccination program in NYC was instrumental to substantially reducing the COVID-19 burden and suppressing a surge of cases attributable to more transmissible variants . As the Delta variant sweeps predominantly among unvaccinated individuals, our findings underscore the urgent need to accelerate vaccine uptake and close the vaccination coverage gaps., Funding: This study was supported by The Commonwealth Fund., Competing Interests: None., (© 2021 Published by Elsevier Ltd.)
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- 2022
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35. Increasing Equity While Improving the Quality of Care: JACC Focus Seminar 9/9.
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Schneider EC, Chin MH, Graham GN, Lopez L, Obuobi S, Sequist TD, and McGlynn EA
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- Cardiovascular Diseases therapy, Humans, Systemic Racism, Health Equity, Healthcare Disparities ethnology, Quality Improvement
- Abstract
This review summarizes racial and ethnic disparities in the quality of cardiovascular care-a challenge given the fragmented nature of the health care delivery system and measurement. Health equity for all racial and ethnic groups will not be achieved without a substantially different approach to quality measurement and improvement. The authors adapt a tool frequently used in quality improvement work-the driver diagram-to chart likely areas for diagnosing root causes of disparities and developing and testing interventions. This approach prioritizes equity in quality improvement. The authors demonstrate how this approach can be used to create interventions that reduce systemic racism within the institutions and professions that deliver health care; attends more aggressively to social factors related to race and ethnicity that affect health outcomes; and examines how hospitals, health systems, and insurers can generate effective partnerships with the communities they serve to achieve equitable cardiovascular outcomes., Competing Interests: Funding Support and Author Disclosures Dr Schneider has received salary support from the Commonwealth Fund. Dr Chin was supported in part by the Robert Wood Johnson Foundation Advancing Health Equity: Leading Care, Payment, and Systems Transformation Program Office, the Merck Foundation Bridging the Gap: Reducing Disparities in Diabetes Care National Program Office, and the Chicago Center for Diabetes Translation Research (NIDDK P30 DK092949); and is a member of the Bristol Myers Squibb Company Health Equity Advisory Board and the Blue Cross Blue Shield Health Equity Advisory Panel. Dr Graham has received salary support from Google; and is a member of the National Heart, Lung, and Blood Institute Advisory Council. Dr Lopez has received salary support from the San Francisco VA Medical Center. Dr Obuobi has received salary support from University of Chicago Medicine. Dr Sequist was supported in part by a grant from the Agency for Healthcare Research and Quality R01HS023812; and was supported in part by a grant from the Agency for Healthcare Research and Quality R01HS023812. Dr McGlynn has received salary support from Kaiser Permanente., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2021
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36. Patient-Reported Care Coordination is Associated with Better Performance on Clinical Care Measures.
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Elliott MN, Adams JL, Klein DJ, Haviland AM, Beckett MK, Hays RD, Gaillot S, Edwards CA, Dembosky JW, and Schneider EC
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- Aged, Cross-Sectional Studies, Female, Humans, Patient Care, Patient Reported Outcome Measures, Quality of Health Care, United States epidemiology, Medicare Part C
- Abstract
Background: Prior studies using aggregated data suggest that better care coordination is associated with higher performance on measures of clinical care process; it is unclear whether this relationship reflects care coordination activities of health plans or physician practices., Objective: Estimate within-plan relationships between beneficiary-reported care coordination measures and HEDIS measures of clinical process for the same individuals., Design: Mixed-effect regression models in cross-sectional data., Participants: 2013 Medicare Advantage CAHPS respondents (n=152,069) with care coordination items linked to independently collected HEDIS data on clinical processes., Main Measures: Care coordination measures assessed follow-up, whether doctors had medical records during visits, whether doctors discussed medicines being taken, how informed doctors seemed about specialist care, and help received with managing care among different providers. HEDIS measures included mammography, colorectal cancer screening, cardiovascular LDL-C screening, controlling blood pressure, 5 diabetes care measures (LDL-C screening, retinal eye exam, nephropathy, blood sugar/HbA1c <9%, LCL-C<100 mg/dL), glaucoma screening in older adults, BMI assessment, osteoporosis management for women with a fracture, and rheumatoid arthritis therapy., Key Results: For 9 of the 13 HEDIS measures, within health plans, beneficiaries who reported better care coordination also received better clinical care (p<0.05) and none of the associations went in the opposite direction; HEDIS differences between those with excellent and poor coordination exceeded 5 percentage points for 7 measures. Nine measures had positive associations (breast cancer screening, colorectal cancer screening, cardiovascular care LDL-C screening, 4 of 5 diabetes care measures, osteoporosis management, and rheumatoid arthritis therapy)., Conclusions: Within health plans, beneficiaries who report better care coordination also received higher-quality clinical care, particularly for care processes that entail organizing patient care activities and sharing information among different healthcare providers. These results extend prior research showing that health plans with better beneficiary-reported care coordination achieved higher HEDIS performance scores., (© 2021. Society of General Internal Medicine.)
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- 2021
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37. Missing the Point - How Primary Care Can Overcome Covid-19 Vaccine "Hesitancy".
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Ratzan S, Schneider EC, Hatch H, and Cacchione J
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- Adult, Aged, COVID-19 prevention & control, Humans, Vaccination statistics & numerical data, Vaccination Refusal, COVID-19 Vaccines supply & distribution, Health Promotion methods, Primary Health Care, Vaccination psychology
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- 2021
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38. The Future of Health Policy in a Partisan United States: Insights From Public Opinion Polls.
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Blendon RJ, Benson JM, and Schneider EC
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- Health Care Reform legislation & jurisprudence, Humans, Racism, Surveys and Questionnaires, United States, Universal Health Insurance, Health Policy legislation & jurisprudence, Healthcare Disparities, National Health Insurance, United States legislation & jurisprudence, Politics, Public Opinion
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- 2021
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39. Strange Bedfellows: Coordinating Medicare and Medicaid to Achieve Cost-Effective Care for Patients with the Greatest Health Needs.
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Elmaleh-Sachs A and Schneider EC
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- Adult, Aged, Cost-Benefit Analysis, Eligibility Determination, Humans, United States, Medicaid, Medicare
- Abstract
This perspective describes federal efforts in the United States (U.S.) to integrate care for an especially complex, vulnerable, and costly patient population: adults eligible for both Medicare and Medicaid insurance. The goal of the paper is to demystify for clinical policy leaders and practicing clinicians the origins and evolution of the Dual-Eligible Special Needs Plans (D-SNPs) recently permanently authorized by the U.S. Congress and to explore the potential for these policy changes to help such health plans improve care for the sickest and most vulnerable Americans.
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- 2020
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40. Association of open communication and the emotional and behavioural impact of medical error on patients and families: state-wide cross-sectional survey.
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Prentice JC, Bell SK, Thomas EJ, Schneider EC, Weingart SN, Weissman JS, and Schlesinger MJ
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- Cross-Sectional Studies, Emotions, Humans, Massachusetts, Communication, Medical Errors
- Abstract
Background: How openly healthcare providers communicate after a medical error may influence long-term impacts. We sought to understand whether greater open communication is associated with fewer persisting emotional impacts, healthcare avoidance and loss of trust., Methods: Cross-sectional 2018 recontact survey assessing experience with medical error in a 2017 random digit dial survey of Massachusetts residents. Two hundred and fifty-three respondents self-reported medical error. Respondents were similar to non-respondents in sociodemographics confirming minimal response bias. Time since error was categorised as <1, 1-2 or 3-6 years before interview. Open communication was measured with six questions assessing different communication elements. Persistent impacts included emotional (eg, sadness, anger), healthcare avoidance (specific providers or all medical care) and loss of trust in healthcare. Logistic regressions examined the association between open communication and long-term impacts., Results: Of respondents self-reporting a medical error 3-6 years ago, 51% reported at least one current emotional impact; 57% reported avoiding doctor/facilities involved in error; 67% reported loss of trust. Open communication varied: 34% reported no communication and 24% reported ≥5 elements. Controlling for error severity, respondents reporting the most open communication had significantly lower odds of persisting sadness (OR=0.17, 95% CI 0.05 to 0.60, p=0.006), depression (OR=0.16, 95% CI 0.03 to 0.77, p=0.022) or feeling abandoned/betrayed (OR=0.10, 95% CI 0.02 to 0.48, p=0.004) compared with respondents reporting no communication. Open communication significantly predicted less doctor/facility avoidance, but was not associated with medical care avoidance or healthcare trust., Conclusions: Negative emotional impacts from medical error can persist for years. Open communication is associated with reduced emotional impacts and decreased avoidance of doctors/facilities involved in the error. Communication and resolution programmes could facilitate transparent conversations and reduce some of the negative impacts of medical error., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2020
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41. The Affordable Care Act's Missing Consensus: Values, Attitudes, and Experiences Associated with Competing Health Reform Preferences.
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McIntyre A, Blendon RJ, Benson JM, Findling MG, and Schneider EC
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- Adult, Aged, Delivery of Health Care standards, Female, Government Programs standards, Humans, Male, Middle Aged, Surveys and Questionnaires, United States, Young Adult, Attitude, Health Care Reform legislation & jurisprudence, Health Care Reform methods, Patient Protection and Affordable Care Act, Politics, Public Opinion
- Abstract
Ten years after its enactment, public support for the Affordable Care Act (ACA) still only reaches a scant majority. Candidates for the presidency-and the sitting president-have endorsed health reforms that would radically transition US health care away from the current system upon which the ACA was built. Few opinion surveys to date have captured dominant preferences among alternative health reform policies or characterized attitudes and experiences that might be associated with policy preferences. Using a 2019 nationally representative telephone survey, this article considers how variations in political values, attitudes toward government, and experiences with the health care system relate to competing health reform preferences. Differences between those who favor Medicare for All over building on the ACA largely reflect different levels of satisfaction with the status quo and views of private health insurance. By contrast, differences between ACA supporters and those who would favor replacing it with a state-based alternative reflect sharply different political values and attitudes. Key differences remain significant after controlling for demographic, health, and political characteristics. Overwhelming public support still eludes the ACA, and reaching consensus on future directions for health reform will remain challenging given differences in underlying beliefs., (Copyright © 2020 by Duke University Press.)
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- 2020
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42. How do health care experiences of the seriously ill differ by disease?
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Ganguli I, Blendon RJ, Benson JM, Shah A, and Schneider EC
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- Adolescent, Adult, Aged, Chronic Disease therapy, Female, Hospitalization statistics & numerical data, Humans, Life Change Events, Male, Middle Aged, Quality of Health Care standards, Quality of Health Care statistics & numerical data, Chronic Disease psychology, Patient Satisfaction
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- 2020
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43. Health Care as an Ongoing Policy Project.
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Schneider EC
- Subjects
- Delivery of Health Care economics, Health Care Reform, Humans, Internationality, Life Expectancy, Quality of Health Care, United States, Universal Health Insurance, Delivery of Health Care organization & administration, Health Policy, Health Services Accessibility, Insurance, Health
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- 2020
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44. Fundamentals of U.S. Health Policy - A Basic Training Perspective Series.
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Schneider EC, Malina D, and Morrissey S
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- Longitudinal Studies, Delivery of Health Care, Health Policy
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- 2020
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45. Failing the Test - The Tragic Data Gap Undermining the U.S. Pandemic Response.
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Schneider EC
- Subjects
- Big Data, COVID-19, COVID-19 Testing, Coronavirus Infections epidemiology, Coronavirus Infections mortality, Databases, Factual, Epidemiologic Methods, Humans, Pneumonia, Viral epidemiology, Pneumonia, Viral mortality, SARS-CoV-2, United States epidemiology, Betacoronavirus, Clinical Laboratory Techniques statistics & numerical data, Coronavirus Infections diagnosis, Pandemics prevention & control, Pneumonia, Viral diagnosis, Public Health Surveillance
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- 2020
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46. Social Spending to Improve Population Health - Does the United States Spend as Wisely as Other Countries?
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Tikkanen RS and Schneider EC
- Subjects
- Delivery of Health Care organization & administration, Humans, United States, Delivery of Health Care economics, Health Expenditures, Population Health
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- 2020
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47. Primary Care Physicians' Role In Coordinating Medical And Health-Related Social Needs In Eleven Countries.
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Doty MM, Tikkanen R, Shah A, and Schneider EC
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- Developed Countries, Home Care Services, Humans, Primary Health Care, Surveys and Questionnaires, Continuity of Patient Care, Internationality, Physicians, Primary Care statistics & numerical data, Practice Patterns, Physicians', Social Work
- Abstract
Primary care physicians in the US, like their colleagues in several other high-income countries, are increasingly tasked with coordinating services delivered not just by specialists and hospitals but also by home care professionals and social service agencies. To inform efforts to improve care coordination, the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians queried primary care physicians in eleven high-income countries about their ability to coordinate patients' medical care with specialists, across settings of care, and with social service providers. Compared to physicians in other countries, substantial proportions of US physicians did not routinely receive timely notification or the information needed for managing ongoing care from specialists, after-hours care centers, emergency departments, or hospitals. Primary care practices in a handful of countries, including the US, are not routinely exchanging information electronically outside the practice. Top-performing countries demonstrate the feasibility of improving two-way communication between primary care and other sites of care. The surveyed countries share the challenge of coordinating with social service providers, and the results call for solutions to support primary care physicians.
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- 2020
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48. Financial Hardships Of Medicare Beneficiaries With Serious Illness.
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Kyle MA, Blendon RJ, Benson JM, Abrams MK, and Schneider EC
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- Aged, Female, Humans, Male, Middle Aged, Poverty statistics & numerical data, Surveys and Questionnaires, United States, Financing, Personal statistics & numerical data, Medicare, Severity of Illness Index
- Abstract
In a national survey, seriously ill Medicare beneficiaries described financial hardships resulting from their illness-despite high beneficiary satisfaction with Medicare overall and the fact that many have supplemental insurance. About half reported a serious problem paying medical bills, with prescription drugs proving most onerous.
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- 2019
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49. Using Human-Centered Design to Build a Digital Health Advisor for Patients With Complex Needs: Persona and Prototype Development.
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Bhattacharyya O, Mossman K, Gustafsson L, and Schneider EC
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- Chronic Disease, Humans, Research Design, Delivery of Health Care methods, Health Planning methods
- Abstract
Background: Twenty years ago, a "Guardian Angel" or comprehensive digital health advisor was proposed to empower patients to better manage their own health. This is now technically feasible, but most digital applications have narrow functions and target the relatively healthy, with few designed for those with the greatest needs., Objective: The goal of the research was to identify unmet needs and key features of a general digital health advisor for frail elderly and people with multiple chronic conditions and their caregivers., Methods: In-depth interviews were used to develop personas and use cases, and iterative feedback from participants informed the creation of a low-fidelity prototype of a digital health advisor. Results were shared with developers, investors, regulators, and health system leaders for suggestions on how this could be developed and disseminated., Results: Patients highlighted the following goals: "live my life," "love my life," "manage my health," and "feel understood." Patients and caregivers reported interest in four functions to address these goals: tracking and insights, advice and information, providing a holistic picture of the patient, and coordination and communication. Experts and system stakeholders felt the prototype was technically feasible, and that while health care delivery organizations could help disseminate such a tool, it should be done in partnership with consumer-focused organizations., Conclusions: This study describes the key features of a comprehensive digital health advisor, but to spur its development, we need to clarify the business case and address the policy, organizational, and cultural barriers to creating tools that put patients and their goals at the center of the health system., (©Onil Bhattacharyya, Kathryn Mossman, Lovisa Gustafsson, Eric C Schneider. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.05.2019.)
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- 2019
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50. Effectiveness of a multistate quality improvement campaign in reducing risk of surgical site infections following hip and knee arthroplasty.
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Calderwood MS, Yokoe DS, Murphy MV, DeBartolo KO, Duncan K, Chan C, Schneider EC, Parry G, Goldmann D, and Huang S
- Subjects
- Aged, Aged, 80 and over, Evidence-Based Practice, Female, Health Care Surveys, Humans, Male, Medicare, Middle Aged, Program Evaluation, Surgical Wound Infection economics, Surgical Wound Infection epidemiology, United States epidemiology, Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Knee adverse effects, Arthroplasty, Replacement, Knee statistics & numerical data, Insurance Claim Review statistics & numerical data, Quality Improvement, Surgical Wound Infection prevention & control
- Abstract
Background: Quality improvement (QI) campaigns appear to increase use of evidence-based practices, but their effect on health outcomes is less well studied., Objective: To assess the effect of a multistate QI campaign (Project JOINTS, Joining Organizations IN Tackling SSIs) that used the Institute for Healthcare Improvement's Rapid Spread Network to promote adoption of evidence-based surgical site infection (SSI) prevention practices., Methods: We analysed rates of SSI among Medicare beneficiaries undergoing hip and knee arthroplasty during preintervention (May 2010 to April 2011) and postintervention (November 2011 to September 2013) periods in five states included in a multistate trial of the Project JOINTS campaign and five matched comparison states. We used generalised linear mixed effects models and a difference-in-differences approach to estimate changes in SSI outcomes., Results: 125 070 patients underwent hip arthroplasty in 405 hospitals in intervention states, compared with 131 787 in 525 hospitals in comparison states. 170 663 patients underwent knee arthroplasty in 397 hospitals in intervention states, compared with 196 064 in 518 hospitals in comparison states. After the campaign, patients in intervention states had a 15% lower odds of developing hip arthroplasty SSIs (OR=0.85, 95% CI 0.75 to 0.96, p=0.01) and a 12% lower odds of knee arthroplasty SSIs than patients in comparison states (OR=0.88, 95% CI 0.78 to 0.99, p=0.04)., Conclusions: A larger reduction of SSI rates following hip and knee arthroplasty was shown in intervention states than in matched control states., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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