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3. Early impact of the implementation of Medicaid episode-based payment reforms in Arkansas

Author

Toth, Matt, Moore, Paul, Tant, Elizabeth, Rutledge, Regina, Beil, Heather, Arbes, Sam, West, Nathan, and West, Suzanne L.

Subjects
Arkansas -- Health aspects, United States. Centers for Medicare and Medicaid Services -- Powers and duties, Powers and duties, Care and treatment, Analysis, Health aspects, Health care costs -- Analysis, Medicaid -- Analysis, Respiratory tract infections -- Care and treatment
Abstract

1 I INTRODUCTION The Centers for Medicare and Medicaid Services (CMS) have focused on efforts to move away from fee-for-service (FFS)-based payment toward value-based purchasing to improve quality of care [...], Objective: To evaluate episode-based payments for upper respiratory tract infections (URI) and perinatal care in Arkansas's Medicaid population. Study Setting: Upper respiratory infection and perinatal episodes among Medicaid-covered individuals in Arkansas and comparison states from fiscal year (FY) 2011 to 2014. Study Design: Cross-sectional observational analysis using a difference-in-difference design to examine outcomes associated with URI and perinatal episodes of care (EOC) from 2011 to 2014. Key dependent variables include antibiotic use, emergency department visits, physician visits, hospitalizations, readmission, and preventive screenings. Data Collection: Claims data from the Medicaid Analytic Extract for Arkansas, Mississippi, and Missouri from 2010 to 2014 with supplemental county-level data from the Area Health Resource File (AHRF). Principal Findings: The URI EOC reduced the probability of antibiotic use (marginal effect [ME] = -1.8, 90% CI: -2.2, -1.4), physician visits (ME = 0.6, 90% CI: -0.8, -0.4), improved the probability of strep tests for children diagnosed with pharyngitis (ME = 9.4, 90% CI: 8.5, 10.3), but also increased the probability of an emergency department (ED) visit (ME = 0.1, 90% CI: 0.1, 0.2), relative to the comparison group. For perinatal EOCs, we found a reduced probability of an ED visit during pregnancy (ME = 0.1, 90% CI: -0.2, -0.0). an increased probability of screening for HIV (ME = 6.2, 90% CI: 4.0, 8.5), chlamydia (ME = 9.5, 90% CI: 7.2, 11.8), and group [BETA] strep-test (ME = 2.6, 90% CI: 0.5,4.6). relative to the comparison group. Predelivery and postpartum hospitalizations also increased (ME = 1.2,90% CI: 0.4,2.0; ME = 0.4, 90% CI: 0.0,0.8. respectively), relative to the comparison group. Conclusion: Upper respiratory infection and perinatal EOCs for Arkansas Medicaid beneficiaries produced mixed results. Aligning shared savings with quality metrics and cost-thresholds may help achieve quality targets and disincentivize over utilization within the EOC, but may also have unintended consequences. KEYWORDS bundled payment, Medicaid, perinatal care, upper respiratory infection, utilization

Published
2020
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14. Information Extraction from Medical Notes

Author

Kraus, Scott, Blake, Catherine, West, Suzanne L, and Medinfo 2007: Proceedings of the 12th World Congress on Health (Medical) Informatics; Building Sustainable Health Systems

Published
2007

15. Reflections on the use of electronic health record data for clinical research

Author

West, Suzanne L., Blake, Catherine, Zhiwen Liu, McKoy, J. Nikki, Oertel, Maryann D., and Carey, Timothy S.

Subjects
E-health -- Usage, Medical care -- Quality management, Medical care -- Management, Company business management, Computers and office automation industries, Health, Health Insurance Portability and Accountability Act of 1996
Published
2009

22. Similar Effectiveness of Paroxetine, Fluoxetine, and Sertraline in Primary Care: A Randomized Trial. (Original Contribution)

Author

Kroenke, Kurt, West, Suzanne L., Swindle, Ralph, Gilsenan, Alicia, Eckert, George J., Dolor, Rowena, Stang, Paul, Zhou, Xiao-Hua, Hays, Ron, and Weinberger, Morris

Subjects
Serotonin uptake inhibitors -- Evaluation, Depression, Mental -- Drug therapy
Abstract

Different selective serotonin reuptake inhibitors (SSRIs) appear to be equally effective in treating depression, according to researchers who evaluated paroxetine, fluoxetine, and sertraline in a study of 573 patients. Compared to other antidepressants, SSRIs have fewer side effects., Context: Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed class of antidepressant, yet it is not known whether one SSRI is more effective than another. Objective: To compare the effectiveness of 3 SSRIs (paroxetine, fluoxetine, and sertraline) in depressed primary care patients. Design: Open-label, randomized, intention-to-treat trial, with patient enrollment occurring in April-November 1999. Setting: Thirty-seven clinics in 2 US primary care research networks. Patients: A total of 573 depressed adult patients for whom their primary care physician thought that antidepressant therapy was warranted and who completed a baseline interview. Interventions: Patients were randomly assigned to receive paroxetine (n = 189), fluoxetine (n=193), or sertraline (n=191) for 9 months. Primary care physicians were allowed to switch patients to a different SSRI or non-SSRI antidepressant if they did not adequately respond to or tolerate the initial SSRI. Main Outcome Measures: The primary outcome measure was change in the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Mental Component Summary score (range, 0-100), compared across treatment groups at 1, 3, 6, and 9 months. Secondary outcomes included other depression and psychological measures, multiple measures of social and work functioning, and other domains of health-related quality of life, such as physical functioning, concentration and memory, vitality, bodily pain, sleep, and sexual functioning. Results: Follow-up interviews were successfully completed in 94% of patients at 1 month, 87% at 3 months, 84% at 6 months, and 79% at 9 months. Responses to the 3 SSRIs were comparable on all measures and at all time points. The mean change in the SF-36 Mental Component Summary score at 9 months was + 15.8 in the paroxetine group, + 15.1 in the fluoxetine group, and + 17.4 in the sertraline group. The drugs were also associated with similar incidences of adverse effects and discontinuation rates. Conclusions: The SSRI antidepressants paroxetine, fluoxetine, and sertraline were similar in effectiveness for depressive symptoms as well as multiple domains of health-related quality of life over the entire 9 months of this trial.

Published
2001

26. supplemental_material_iq_final – Supplemental material for Did Arkansas’ Medicaid Patient-Centered Medical Home Program Have Spillover Effects on Commercially Insured Enrollees?

Author

Hinde, Jesse M., West, Nathan, Arbes, Samuel J., Kluckman, Marianne, and West, Suzanne L.

Subjects
111099 Nursing not elsewhere classified, FOS: Health sciences
Abstract

Supplemental material, supplemental_material_iq_final for Did Arkansas’ Medicaid Patient-Centered Medical Home Program Have Spillover Effects on Commercially Insured Enrollees? by Jesse M. Hinde, Nathan West, Samuel J. Arbes, Marianne Kluckman and Suzanne L. West in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Published
2020
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48. A systematic review of the literature on female sexual dysfunction prevalence and predictors

Author

West, Suzanne L., Vinikoor, Lisa C., and Zolnoun, Denniz

Subjects
Sex education -- Analysis, Sexual disorders -- Analysis, Sexual excitement -- Analysis, Health, Psychology and mental health
Abstract

A systematic review on the prevalence of female sexual dysfunction overall, and more specifically, on sexual desire disorder, arousal difficulties, anorgasmia, and dyspareunia is conducted. A quality assessment defining quality based on the representativeness of the population and the rigor instruments used for assessing sexual dysfunction are performed.

Published
2004

49. Moving from Quality Measurement to Quality Improvement: Applying Meaningful Use Lessons to the Quality Payment Program.

Author

Hersey, Catherine L., Tant, Elizabeth, Berzin, Olivia K. G., Trisolini, Michael G., and West, Suzanne L.

Abstract

Although the federal electronic health record (EHR) incentive program has ended, the need to effectively implement and use EHRs has not. The advent of the federal Quality Payment Program (QPP) has made effective use of EHRs more critical than ever, especially for clinical quality measurement and improvement. However, practices continue to face challenges in successfully implementing and using EHRs to achieve these aims. We used a multiple case study approach to understand how physician practices were using EHR data to measure and improve quality. We interviewed a variety of physicians and staff at multiple practices of diverse sizes and settings. Our findings suggest specific approaches that can help practices better harness their EHR data to measure and improve the quality of care while reducing or preventing staff dissatisfaction and burnout. These lessons can help practices better leverage their EHRs to succeed in the QPP. [ABSTRACT FROM AUTHOR]

Published
2019

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