Jeffrey S Harman

Langston University, Langston, Oklahoma, United States

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Publications (88)211.19 Total impact

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    ABSTRACT: To determine the effect of clinical presentations of neck pain on short term physical therapy outcomes. Retrospective analysis of pair matched groups from a clinical cohort SETTING: 13 outpatient physical therapy clinics in one healthcare system. 1069 patients grouped by common clinical presentations of neck pain: Nonspecific neck pain (NSNP) with a duration less than 4weeks, NSNP greater than 4weeks, neck pain with arm pain, neck pain with headache and whiplash. Conservative interventions provided by physical therapists MAIN OUTCOME MEASURES: Neck Disability Index (NDI) and Numerical Pain Rating Scale (NPRS) recorded at the initial and last visits. The main outcome of interest was achieving recovery status on the NDI. Change in NDI and NPRS were compared between clinical presentation groups. Compared to patients presenting with NSNP >4weeks, patients with NSNP <4weeks had increased odds of achieving recovery status on the NDI (p<0.0001), demonstrated the greatest changes in clinical outcomes of pain (p=<0.0001) and disability (p=<0.0001). Patients with neck pain and arm pain demonstrated an increased odds of achieving recovery status on the NDI (p=0.03) compared to patients presenting with NSNP >4weeks. Treating patients with NSNP within <4weeks of onset of symptoms may lead to improved clinical outcomes from physical therapy compared to other common clinical presentations. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Jul 2015 · Archives of physical medicine and rehabilitation
  • Haichang Xin · Jeffrey S. Harman
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    ABSTRACT: Objective: The study examined whether high cost-sharing policies for physician care are associated with reduced care utilization and costs differently between individuals with and without chronic conditions. Findings from this study contribute to the benefit structure design of health plans that may improve care delivery efficiencies and maintain health outcomes among chronically ill individuals. Methods: The study used the 2010-2011 national sample data with a retrospective cohort study design. Difference in difference, negative binomial regression, and generalized linear model were employed to analyze the utilization and cost data. In order to account for national survey sampling design, weight and variance were adjusted. Results: The study sample consisted of 4,368 individuals. Multivariate analysis and sensitivity analysis found consistent patterns between utilization and cost models. High cost-sharing policies for physician care were not associated with different levels of reductions in care utilization and costs between chronically ill people and healthy people (all at p > 0.05). However, the stratification analysis indicated that chronically ill people reduced physician care use and costs to the similarly significant extent as healthy people in response to high cost-sharing policies. Conclusions: Relative to non-chronically ill individuals, chronically ill individuals may decrease their care utilization and expenditures to a similarly significant extent in response to increased physician care cost-sharing. This may be due to patients’ inability to discern care cost-effectiveness, a short observation window, and chronic condition characteristics. It is possible that, in the long run, these sick people would demonstrate substantial demands for downstream medical care, such as inpatient care, and there could ultimately be a total cost increase for them and their families at the micro level. Health plans need to be cautious of policies for chronically ill private enrollees, such as considering a low cost-sharing policy for physician care or primary care. Individuals with chronic conditions may consider insurance plans with low levels of cost-sharing in physician care, especially when more public information about health plans features and designs is available to facilitate their decision making process. Future studies should examine this research question with a longer observation period and with more measures, such as physician behaviors.
    No preview · Article · Jun 2015 · World Medical and Health Policy
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    ABSTRACT: In efforts to decrease practice variation, clinical practice guidelines for neck pain have been published. The purpose of this study was to determine the effect of receiving guideline adherent physical therapy (PT) on clinical outcomes, health care utilization, and charges for health care services in patients with neck pain. A retrospective review of 298 patients with neck pain receiving PT from 2008 to 2011 was performed. Clinical outcomes, utilization, and charges were compared between patients who received guideline adherent care and nonadherent care. Patients in the adherent care group experienced a lower percentage improvement in pain score compared to nonadherent care group (p = .01), but groups did not significantly differ on percentage improvement in disability (p = .32). However, patients receiving adherent care had an average 3.6 fewer PT visits (p < .001) and less charges for PT (p < .001). Additionally, patients receiving adherent care had 7.3 fewer visits to other health care providers (p < .001), one less prescription medication (p = .02) and 43% fewer diagnostic images (p = .02) but did not differ in their charges to other health care providers (p = .68) during the calendar year of undergoing PT. Although receiving guideline adherent care demonstrated positive effects on health care utilization and financial outcomes, there appears to be a trade-off with clinical outcomes. © The Author(s) 2015.
    No preview · Article · Apr 2015 · Evaluation & the Health Professions
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    ABSTRACT: PurposeRural-dwelling Department of Veterans Affairs (VA) enrollees are at high risk for a wide variety of mental health-related disorders. The objective of this study is to examine the variation in the types of mental and nonmental health services received by rural VA enrollees who have a mental health-related diagnosis.Methods The Andersen and Aday behavioral model of health services use and the Agency for Healthcare Research and Quality Medical Expenditure Panel Survey (MEPS) data were used to examine how VA enrollees with mental health-related diagnoses accessed places of care from 1999 to 2009. Population survey weights were applied to the MEPS data, and logit regression was conducted to model how predisposing, enabling, and need factors influence rural veteran health services use (measured by visits to different places of care). Analyses were performed on the subpopulations: rural VA, rural non-VA, urban VA, and urban non-VA enrollees.FindingsFor all types of care, both rural and urban VA enrollees received care from inpatient, outpatient, office-based, and emergency room settings at higher odds than urban non-VA enrollees. Rural VA enrollees also received all types of care from inpatient, office-based, and emergency room settings at higher odds than urban VA enrollees. Rural VA enrollees had higher odds of a mental health visit of any kind compared to urban VA and non-VA enrollees.Conclusions Based on these variations, the VA may want to develop strategies to increase screening efforts in inpatient settings and emergency rooms to further capture rural VA enrollees who have undiagnosed mental health conditions.
    No preview · Article · Jan 2015 · The Journal of Rural Health
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    ABSTRACT: Background: Physicians in the U.S. are adopting electronic health records (EHRs) at an unprecedented rate. However, little is known about how EHR use relates to physicians' care decisions. Using nationally representative data, we estimated how using practice-based EHRs relates to opioid prescribing in primary care. Methods: This study analyzed 33,090 visits to primary care physicians (PCPs) in the 2007-2010 National Ambulatory Medical Care Survey. We used logistic regression to compare opioid prescribing by PCPs with and without EHRs. Results: Thirteen percent of all visits and 33 % of visits for chronic noncancer pain resulted in an opioid prescription. Compared to visits without EHRs, visits to physicians with EHRs had 1.38 times the odds of an opioid prescription (95 % CI, 1.22-1.56). Among visits for chronic noncancer pain, physicians with EHRs had significantly higher odds of an opioid prescription (adj. OR = 1.39; 95 % CI, 1.03-1.88). Chronic pain visits involving electronic clinical notes were also more likely to result in an opioid prescription compared to chronic pain visits without (adj. OR = 1.51; 95 % CI, 1.10-2.05). Chronic pain visits involving electronic test ordering were also more likely to result in an opioid prescription compared to chronic pain visits without (adj. OR = 1.31; 95 % CI, 1.01-1.71). Conclusions: We found higher levels of opioid prescribing among physicians with EHRs compared to those without. These results highlight the need to better understand how using EHR systems may influence physician prescribing behavior so that EHRs can be designed to reliably guide physicians toward high quality care.
    No preview · Article · Nov 2014 · Journal of Medical Systems
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    ABSTRACT: STUDY DESIGN: Retrospective analysis of episodes of care. OBJECTIVE: To assess the implications of practice setting (hospital outpatient settings versus private practice) on clinical outcomes and efficiency of care in the delivery of physical therapy services. BACKGROUND: Many patients with musculoskeletal conditions benefit from care provided by physical therapists. The majority of physical therapists deliver services in either a private practice setting or in a hospital outpatient setting. There have not been any recent studies comparing whether clinical outcomes or efficiency of care differ based on practice setting. METHODS: Practices that use the Focus On Therapeutic Outcomes, Inc system were surveyed to determine the specific type of setting in which outcomes were collected in patients with musculoskeletal impairments. Patient outcome data over 12 months (2011-2012) were extracted from the database and analyzed to identify differences in the functional status achieved and the efficiency of the care delivery process between private practices and hospital outpatient settings. RESULTS: The data suggest that patients experience more efficient care when receiving physical therapy in hospital outpatient settings compared to private practice settings, as demonstrated by 3.1 points of greater improvement in functional status over 2.9 fewer physical therapy visits. However, the difference in improvement between settings is less than the minimum clinically important difference of 9 points in functional status outcome score. CONCLUSION: In this cohort, our data suggest that more efficient care was delivered in the hospital outpatient setting compared to the private practice setting. However, we cannot conclude that care delivered in the hospital setting is more cost-effective, because it is possible that any difference in efficiency of care favoring the hospital outpatient setting is more than offset by higher costs of care.
    Full-text · Article · Oct 2014 · Journal of Orthopaedic and Sports Physical Therapy
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    ABSTRACT: Objective Subarachnoid hemorrhage (SAH) is a particularly devastating type of stroke which is responsible for one third of all stroke-related years of potential life lost before age 65. Surgical treatment has been shown to decrease both morbidity and mortality after subarachnoid hemorrhage. We hypothesized that payer status other than private insurance is associated with lower allocation to surgical treatment for patients with SAH and worse outcomes. Design We examined the association between insurance type and surgical treatment allocation and outcomes for patients with SAH while adjusting for a wide range of patient and hospital factors. We analyzed the Nationwide Inpatient Sample hospital discharge database using survey procedures to produce weighted estimates representative of the United States population. Patients We studied 21047 discharges, representing a weighted estimate of 102595 patients age 18 and above with a discharge diagnosis of SAH between 2003 and 2008. Measurements Multivariable logistic and generalized linear regression analyses were used to assess for any associations between insurance status and surgery allocation and outcomes. Main Results Despite the benefits of surgery 66% of SAH patients did not undergo surgical treatment to prevent rebleeding. Mortality was more than twice as likely for patients with no surgical treatment compared to those who received surgery. Medicare patients were significantly less likely to receive surgical treatment. Conclusions Nearly two thirds of patients with SAH don't receive operative care, and Medicare patients were significantly less likely to receive surgical treatment than other patients. Bias against the elderly and those with chronic illness and disability may play a part in these findings. A system of regionalized care for patients presenting with SAH may reduce disparities and improve appropriate allocation to surgical care and deserves prospective study.
    Full-text · Article · Aug 2014 · PLoS ONE
  • Haichang Xin · Jeffrey S Harman · Zhou Yang
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    ABSTRACT: Objective: This study examines whether high cost-sharing in physician care is associated with a differential impact on total care costs by health status. Total care includes physician care, emergency room (ER) visits and inpatient care. Background: Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients. Methods: This study used the 2007 Medical Expenditure Panel Survey data with a cross-sectional study design. Difference in difference (DID), instrumental variable technique, two-part model, and bootstrap technique were employed to analyze cost data. Results: Chronically ill individuals' probability of reducing any overall care costs was significantly less than healthier individuals (beta = 2.18, p = 0.04), while the integrated DID estimator from split results indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). Conclusions: This greater cost reduction in total care among sick people likely resulted from greater cost reduction in physician care, and may have come at the expense of jeopardizing health outcomes by depriving patients of needed care. Thus, these policies would be inappropriate in the short run, and unlikely in the long run to control health plans costs among chronically ill individuals. A generous benefit design with low cost-sharing policies in physician care or primary care is recommended for both health plans and chronically ill individuals, to save costs and protect these enrollees' health status.
    No preview · Article · Jul 2014 · Journal of insurance medicine (New York, N.Y.)
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    Swathy Sundaram · Jeffrey S Harman · Robert L Cook
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    ABSTRACT: Purpose: Postpartum depression (PPD) is common and associated with significant health outcomes and other consequences. Identifying persons at risk may improve screening and detection of PPD. This exploratory study sought to identify the morbidities that associate with 1) PPD symptoms and 2) PPD diagnosis. Methods: Data from the 2007 and 2008 Pregnancy Risk Assessment Monitoring System were analyzed from 23 states and 1 city (n = 61,733 pregnancies); 13 antenatal morbidities were included. To determine whether antenatal morbidity predictors of PPD would differ based on PPD symptoms versus a diagnosis, each of the 13 antenatal morbidities were examined in separate logistic regression models with each PPD outcome. For each objective, two samples were examined: 1) Women from all states and 2) women from Alaska and Maine, the two states that included both PPD symptoms and PPD diagnosis measures in their questionnaires. Control variables included demographic and sociodemographic variables, pregnancy variables, antenatal and postpartum health behaviors, and birth outcomes. Main findings: Having vaginal bleeding (odds ratio [OR], 1.42; OR, 1.76), kidney/bladder infection (OR, 1.59; OR, 1.63), nausea (OR, 1.50; OR, 1.80), preterm labor (OR, 1.54; OR, 1.51), or being on bed rest (OR, 1.34; OR, 1.56) associated with both PPD symptoms and PPD diagnosis, respectively. Being in a car accident associated with PPD symptoms only (OR, 1.65), whereas having hypertension (OR, 1.94) or a blood transfusion (OR, 2.98) was associated with PPD diagnosis only. Among women from Alaska or Maine, having preterm labor (OR, 2.54, 2.11) or nausea (OR, 2.15, 1.60) was associated with both PPD symptoms and PPD diagnosis, respectively. Having vaginal bleeding (OR, 1.65), kidney/bladder infection (OR, 1.74), a blood transfusion (OR, 3.30), or being on bed rest (OR, 1.87) was associated with PPD symptoms only, whereas having diabetes before pregnancy (OR, 5.65) was associated with PPD diagnosis only. Conclusions: The findings of this exploratory study revealed differences in the antenatal morbidities that were associated with PPD symptoms versus diagnosis in both samples, and can assist prenatal care providers in prioritizing and screening for these morbidities that are associated with PPD during pregnancy. Additional research is warranted to confirm the results of this study in other samples and populations. Developing strategies to 1) improve general awareness of PPD and the appropriate antenatal morbidity risk factors to focus on in clinical settings, and 2) increase screening for the antenatal morbidities determined to be predictors of PPD in this study are warranted in preventing PPD.
    Preview · Article · Jul 2014 · Women s Health Issues
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    ABSTRACT: Background: There is growing and sustained recognition that Patient-Centered Medical Homes (PCMHs) represent a viable approach to dealing with the fragmentation of care faced by many individuals, including those living with diabetes. The National Committee for Quality Assurance (NCQA) has spearheaded a program that recognizes medical practices that adopt key elements of the PCMH. Even though practices can achieve the same level of recognition, it is unclear whether all PCMHs deliver care in the same manner and how these differences can be associated with patient ratings of their experience with care. Methods: This study uses a mixed-methods approach to explore differences in care delivery across 4 NCQA level 3 recognized PCMHs located in a southern state. Furthermore, the study examines the association between each clinic and patient ratings of key PCMH domains. The qualitative component of the study included in-depth interviews with medical directors at each site in order to determine how the PCMH at each clinic was operationalized. In addition, 1300 adult patients with diabetes were surveyed about their experiences with their PCMH. Bivariate and ordinal logistical analyses were conducted to determine how PCMH experiences varied across the 4 clinics. Results: The in-depth interviews revealed that one clinic (clinic 1) had a stronger primary care orientation relative to the other locations. Furthermore, patients at these clinics were more likely to provide higher ratings of care across all PCMH domains. Conclusions: This study demonstrates that not all PCMH clinics are alike and that these differences can possibly affect patient perceptions of their care.
    No preview · Article · Jun 2014 · Journal of primary care & community health
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    ABSTRACT: Research Objectives: The AIM of this study was to compare the distribution of nationally certified nurse practitioners’ (NP) practice location between states with and without restrictions on NP independent practice to determine whether states which allow for independent NP practice are more likely to have NPs practicing in medically underserved areas (MUAs). Study Design: Geographic Information System (GIS) methods were conducted that pinpointed descriptive locations of NPs, all 241,618 practicing primary care physicians (PCPs) in the U.S, and MUAs and Health Professional Shortage Areas (HPSAs) to a spatial mapping surface. To quantify the distribution of NPs and PCPs in each state, geospatial databases that summarized the spatial dispersal of NPs and PCPs and highlight disparities and clusters were created. The probability of a MUA/HPSA having no primary health care provider and the probability of having an NP but no PCP in the MUA/HPSA was calculated and compared. Population Studied: Mailing addresses for NPs and PCPs were acquired from American Association of Nurse Practitioners and the American Medical Association (AMA) Master file respectively: NP data included 21,211 addresses records and the AMA Master file data had 241,618 addresses of PCPs. Principal Findings: We successfully geocoded 99.76% of NP and 99.99% of PCP addresses. Just over one in five MUAs had no primary health care providers (21%) overall, with the highest percentage occurring in states which allowed for independent NP practice (29%), followed by states that required complete supervision (21%) and states that only required supervision of prescribing (17%). There were greater odds of MUA having an NP but no PCPs in states with the least restrictions on NP independent practice, (p=.08). Conclusions: There is an unequal distribution of primary health care providers (NPs and PCPs) in the US such that some geographic areas (MUAs) have few or no providers. Although states that allow for independent NP practice had the highest proportion of MUAs/HPSAs with no primary care providers, those states were more likely to have MUAs that did not have access to a PCP but did have access to a NP. Implications for Policy, Delivery or Practice: Implementation of the Affordable Care Act this year will create millions of new consumers who will be able to afford care, but with the shortage of primary care providers in medically underserved areas, care may not be available to them. Because the conduit to NP autonomy and full scope of practice is limited by state-based practice regulations imposed by state boards of nursing some states negatively impact the NPs’ authority to provide primary care to the full extent of their education, certification, and training, including their ability to prescribe medications and order tests, to be reimbursed, and to be primary care providers of record.
    No preview · Conference Paper · Jun 2014
  • Swathy Sundaram · Jeffrey S. Harman · Robert L. Cook
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    ABSTRACT: Purpose Postpartum depression (PPD) is common and associated with significant health outcomes and other consequences. Identifying persons at risk may improve screening and detection of PPD. This exploratory study sought to identify the morbidities that associate with 1) PPD symptoms and 2) PPD diagnosis. Methods Data from the 2007 and 2008 Pregnancy Risk Assessment Monitoring System were analyzed from 23 states and 1 city (n = 61,733 pregnancies); 13 antenatal morbidities were included. To determine whether antenatal morbidity predictors of PPD would differ based on PPD symptoms versus a diagnosis, each of the 13 antenatal morbidities were examined in separate logistic regression models with each PPD outcome. For each objective, two samples were examined: 1) Women from all states and 2) women from Alaska and Maine, the two states that included both PPD symptoms and PPD diagnosis measures in their questionnaires. Control variables included demographic and sociodemographic variables, pregnancy variables, antenatal and postpartum health behaviors, and birth outcomes. Main Findings Having vaginal bleeding (odds ratio [OR], 1.42; OR, 1.76), kidney/bladder infection (OR, 1.59; OR, 1.63), nausea (OR, 1.50; OR, 1.80), preterm labor (OR, 1.54; OR, 1.51), or being on bed rest (OR, 1.34; OR, 1.56) associated with both PPD symptoms and PPD diagnosis, respectively. Being in a car accident associated with PPD symptoms only (OR, 1.65), whereas having hypertension (OR, 1.94) or a blood transfusion (OR, 2.98) was associated with PPD diagnosis only. Among women from Alaska or Maine, having preterm labor (OR, 2.54, 2.11) or nausea (OR, 2.15, 1.60) was associated with both PPD symptoms and PPD diagnosis, respectively. Having vaginal bleeding (OR, 1.65), kidney/bladder infection (OR, 1.74), a blood transfusion (OR, 3.30), or being on bed rest (OR, 1.87) was associated with PPD symptoms only, whereas having diabetes before pregnancy (OR, 5.65) was associated with PPD diagnosis only. Conclusions The findings of this exploratory study revealed differences in the antenatal morbidities that were associated with PPD symptoms versus diagnosis in both samples, and can assist prenatal care providers in prioritizing and screening for these morbidities that are associated with PPD during pregnancy. Additional research is warranted to confirm the results of this study in other samples and populations. Developing strategies to 1) improve general awareness of PPD and the appropriate antenatal morbidity risk factors to focus on in clinical settings, and 2) increase screening for the antenatal morbidities determined to be predictors of PPD in this study are warranted in preventing PPD.
    No preview · Article · Jan 2014
  • Jeffrey S Harman · Allyson G Hall · Christy H Lemak · R Paul Duncan
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    ABSTRACT: To determine the impact of Florida's Medicaid Demonstration 4 years post-implementation on per member per month (PMPM) Medicaid expenditures and whether receiving care through HMOs versus provider service networks (PSNs) in the Demonstration was associated with PMPM expenditures. Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration (FY0405, FY0506) and the first four fiscal years after implementation (FY0607-FY0910) from two urban Demonstration counties and two urban non-Demonstration counties. A difference-in-difference approach was used to compare changes in enrollee expenditures before and after implementation of the Demonstration overall and specifically for HMOs and PSNs. Claims data were extracted for enrollees in the Demonstration and non-Demonstration counties and collapsed into monthly amounts (N = 26,819,987 person-months). Among SSI enrollees, the Demonstration resulted in lower increases in PMPM expenditures over time ($40) compared with the non-Demonstration counties ($186), with Demonstration PSNs lowering PMPM expenditures by $7 more than HMOs. Savings were also seen among TANF enrollees but to a lesser extent. The Medicaid Demonstration in Florida appears to result in lower PMPM expenditures. Demonstration PSNs generated slightly greater reductions in expenditures compared to Demonstration HMOs. PSNs appear to be a promising model for delivering care to Medicaid enrollees.
    No preview · Article · Nov 2013 · Health Services Research
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    Christopher A Harle · Jeffrey S Harman · Shuo Yang
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    ABSTRACT: Clinical inertia, the failure to adjust antihypertensive medications during patient visits with uncontrolled hypertension, is thought to be a common problem. This retrospective study used 5 years of electronic medical records from a multispecialty group practice to examine the association between physician and patient characteristics and clinical inertia. Hierarchical linear models (HLMs) were used to examine (1) differences in physician and patient characteristics among patients with and without clinical inertia, and (2) the association between clinical inertia and future uncontrolled hypertension. Overall, 66% of patients experienced clinical inertia. Clinical inertia was associated with one physician characteristic, patient volume (odds ratio [OR]=0.998). However, clinical inertia was associated with multiple patient characteristics, including patient age (OR=1.021), commercial insurance (OR=0.804), and obesity (OR=1.805). Finally, patients with clinical inertia had 2.9 times the odds of uncontrolled hypertension at their final visit in the study period. These findings may aid the design of interventions to reduce clinical inertia.
    Preview · Article · Nov 2013 · Journal of Clinical Hypertension
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    Nate L Ewigman · Julius A Gylys · Jeffrey S Harman
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    ABSTRACT: Objective: This study examined the diagnostic patterns for individuals presenting with a complaint of anger. Methods: The study examined the rates of psychiatric diagnoses in a nationally representative sample of visits (N=1,005,628) to outpatient medical settings by adults who presented with a complaint of anger. Data were from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey from 1998-2008. Results: Anger accounted for .14% (N=1,146) of the presenting complaints among all adults and was associated with being uninsured, Medicaid enrollment, Caucasian race, male gender, and younger age. Eighty-four percent of visits with an anger complaint included a psychiatric diagnosis, with 44% of diagnoses characterized as "not otherwise specified." Conclusions: Individuals who presented with a complaint of anger received a range of conventional mental health diagnoses. These findings suggested a pattern of diagnosis of a presenting complaint of anger that may encourage inadequate or improper treatment.
    Preview · Article · Sep 2013 · Psychiatric services (Washington, D.C.)
  • Amy M Kobus · Jeffrey S Harman · Hau D Do · Roger D Garvin
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    ABSTRACT: Patients with depression most frequently present in primary care. Electronic health records (EHR) have the potential to improve depression care through improved clinical documentation and information exchange. This report provides an example of how an EHR can fail to capture important information regarding depression care. A 6-month baseline period in 2009 was defined to identify ambulatory patients age 18 or older in the EHR with an ICD-9 coded new depression diagnosis. Data was abstracted electronically, and charts were reviewed by hand for patient demographics and to assess the clinical documentation of depression screening, diagnosis, and treatment practices among four community-based family medicine clinics. Electronic abstraction of baseline data identified 200 adult patients with a documented new diagnosis of depression. Review of charts by hand was required to obtain clinical documentation of screening (9% of patients), use of diagnostic tools (73%), discussion of treatment options (83%), medication treatment (71%), and follow-up characteristics (75%). Despite having a robust EHR, we encountered significant challenges finding documentation of depression care, which also made it difficult to track and evaluate the implementation of evidence-based treatment. Clinical documentation in the EHR needs to be simplified and standardized if data extraction and exporting processes of clinician performance data are to become efficient and routine practice.
    No preview · Article · Apr 2013 · Family medicine
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    ABSTRACT: Medicare ceased payment for some hospital-acquired infections beginning October 1, 2008, following provisions in the Medicare Modernization Act of 2003 and the Deficit Reduction Act of 2005. We examined the association of this policy with declines in rates of vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infection (CAUTI). Discharge data from the Florida Agency for Healthcare Administration from 2007 to 2011. We compared rates of hospital-acquired vascular catheter-associated infections (HA-VCAI) and catheter-associated urinary tract infections (HA-CAUTI) before and after implementation of the new policy (January 2007 to September 2008 vs. October 2008 to September 2011). This pre-post, retrospective, interrupted time series study was further analyzed with a generalized hierarchical logistic regression, by estimating the probability of a patient acquiring these infections in the hospital, post-policy compared to pre-policy. Pre-policy, 0.12% of admitted patients were diagnosed with CAUTI; of these, 32% were HA-CAUTI. Similarly, 0.24% of admissions were diagnosed as VCAI; of these, 60% were HA-VCAI. Post-policy, 0.16% of admissions were CAUTIs; of these, 31% were HA-CAUTI. Similarly, 0.3% of admissions were VCAIs and, of these, 45% were HA-VCAI. There was a statistically significant decrease in HA-VCAIs (OR: 0.571 (p < 0.0001)) post-policy, but the reduction in HA-CAUTI (OR: 0.968 (p < 0.4484)) was not statistically significant. The results suggest Medicare non payment policy is associated with both a decline in the rate of hospital-acquired VCAI (HA-VCAI) per quarter, and the probability of acquiring HA-VCAI post- policy. The strength of the association could be overestimated, because of concurrent ongoing infection control interventions.
    Preview · Article · Jan 2013 · Medicare and Medicaid Research Review
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    ABSTRACT: Beginning in April 2000 and continuing for 21 months, Florida's legislature allocated $31.6 million (annualized) to nursing homes through a Medicaid direct care staffing adjustment. Florida's legislature paid the highest incentives to nursing homes with the lowest staffing levels and the greatest percentage of Medicaid residents-the bottom tier of quality. Using Donabedian's structure-process-outcomes framework, this study tracks changes in staffing, wages, process of care, and outcomes. The incentive payments increased staffing and wages in nursing home processes (decreased restraint use and feeding tubes) for the facilities receiving the largest amount of money but had no change on pressure sores or decline in activities of daily living. The group receiving the lowest incentives payment (those highest staffed at baseline) saw significant improvement in two quality measures: pressure sores and decline in activities of daily living. All providers receiving more resources improved on deficiency scores, suggesting more Medicaid spending improves quality of care regardless of total incentive payments.
    Full-text · Article · Jan 2013 · Journal of Aging & Social Policy
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    ABSTRACT: Florida Medicaid recently concluded a five year Medicaid managed care demonstration program in 5 counties. A key component of the demonstration was that beneficiaries enroll in one of two types of managed care plans: traditional HMOs and provider service networks (PSNs). There are two structural differences between these two plan types: PSNs were reimbursed based on fee for service, HMOs were capitated; and PSNs were owned by local physician groups or hospitals, most of the HMOs were national organizations. This study explores whether beneficiary reports and ratings of care vary by health plan type, and also before or after mandated Medicaid managed care was introduced. This study involves a secondary analysis of 4 years of CAHPS surveys (n=20,157) of Medicaid beneficiaries. Mulitvariate ordered logit regression models were used to determine whether there were differences in 9 reports and 4 ratings of care by plan type (HMO, PSN) and whether there were changes in reports and ratings before and after mandated Medicaid managed care was introduced. The likelihood of providing a high rating for overall health care declined after the demonstration was implemented (OR .74 95% CI .59,.92). However after the demonstration was initiated, beneficiaries were more likely to provide favorable reports of aspects of their care such as finding a doctor or nurse (OR 1.40 95% CI 1.06, 1.83) or getting care right away (OR 1.48 95% CI 1.08, 2.04), compared to before implementation. PSN enrollees compared to HMO enrollees after implementation relative to before implementation were more likely to provide better ratings for overall health care (OR 1.30 95% CI 1.04, 1.63), personal doctor (OR 1.33 95% CI 1.07, 1.67), and a more favorable report of their doctor spending enough time (OR 1.46 95% CI 1.17, 1.83). PSN enrollees were also more likely to provide specialty care with a favorable rating (OR 1.52 95% CI 1.09, 2.11) compared to HMO enrollees. Findings suggest that although beneficiaries are more likely to rate their overall care negatively after mandated managed care some aspects of their care may have improved , notably the ability to find a doctor and the interactions with that clinician. Experiences under PSN arrangements appear to be preferable to the HMO arrangement.
    No preview · Conference Paper · Oct 2012
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    ABSTRACT: BACKGROUND:: Private equity has acquired multiple large nursing home chains within the last few years; by 2009, it owned nearly 1,900 nursing homes. Private equity is said to improve the financial performance of acquired facilities. However, no study has yet examined the financial performance of private equity nursing homes, ergo this study. PURPOSE:: The primary purpose of this study is to understand the financial performance of private equity nursing homes and how it compares with other investor-owned facilities. It also seeks to understand the approach favored by private equity to improve financial performance-for instance, whether they prefer to cut costs or maximize revenues or follow a mixed approach. METHODOLOGY/APPROACH:: Secondary data from Medicare cost reports, the Online Survey, Certification and Reporting, Area Resource File, and Brown University's Long-term Care Focus data set are combined to construct a longitudinal data set for the study period 2000-2007. The final sample is 2,822 observations after eliminating all not-for-profit, independent, and hospital-based facilities. Dependent financial variables consist of operating revenues and costs, operating and total margins, payer mix (census Medicare, census Medicaid, census other), and acuity index. Independent variables primarily reflect private equity ownership. The study was analyzed using ordinary least squares, gamma distribution with log link, logit with binomial family link, and logistic regression. FINDINGS:: Private equity nursing homes have higher operating margin as well as total margin; they also report higher operating revenues and costs. No significant differences in payer mix are noted. PRACTICE IMPLICATIONS:: Results suggest that private equity delivers superior financial performance compared with other investor-owned nursing homes. However, causes for concern remain particularly with the long-term financial sustainability of these facilities.
    Full-text · Article · May 2012 · Health care management review

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2k Citations
211.19 Total Impact Points

Institutions

  • 2015
    • Langston University
      Langston, Oklahoma, United States
  • 2002-2015
    • University of Florida
      • • Department of Health Services Research, Management and Policy
      • • College of Public Health and Health Professions
      Gainesville, Florida, United States
    • Western Psychiatric Institute and Clinic
      Pittsburgh, Pennsylvania, United States
  • 2009
    • University of Arkansas at Little Rock
      Little Rock, Arkansas, United States
  • 2004
    • The Ohio State University
      • Department of Psychology
      Columbus, OH, United States
  • 2000-2002
    • University of Pittsburgh
      • Department of Psychiatry
      Pittsburgh, Pennsylvania, United States
    • Rutgers, The State University of New Jersey
      • Institute for Health, Health Care Policy and Aging Research
      Нью-Брансуик, New Jersey, United States
  • 2001
    • Childrens Hospital of Pittsburgh
      • Department of Pediatrics
      Pittsburgh, Pennsylvania, United States