CHCPR News

Can personal health care narratives persuade people to use comparative quality information when choosing a physician?

(Posted October 2017)

Testing a Personal Narrative for Persuading People to Value and Use Comparative Physician Quality of Care Information: An Experimental Study
Authors: Jessica Greene, Judith H. Hibbard, Rebecca M. Sacks

The authors conducted an online experiment to test whether a first-person cartoon narrative that educated consumers about physician variation in quality performance could persuade consumers to value and use comparative information on physician quality performance. The cartoon narrative was developed by the Wisconsin Collaborative for Healthcare Quality as part of the Aligning Forces for Quality initiative. The participants were randomized to either view the cartoon character’s narrative, a brief text on physician quality variation, or a control group with no additional information. All participants were shown a display of four physicians, one of whom had the highest quality performance but was more expensive and less convenient. While there was no overall relationship between viewing the narrative or reading text and choosing the top-quality physician, higher numerate participants who viewed the narrative had 2.7 times the odds of selecting the top-quality physician. The results indicate that personal narratives can persuade people with high numeracy skills to consider quality when choosing a physician, and suggest that future research is needed to identify strategies to support those with lower numeracy skills in selecting high-quality health providers.

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The Determinants of Health in Northern Nevada: Preliminary Results from a Large and Expanding Population Health Study

(Posted September 2017)

Dr. Joseph J Grzymski, Co-Director, Renown Institute for Health Innovation, Reno, NV speaks in our Health Services Research Colloquium

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Do Prescription Drug Monitoring Programs (PDMPs) reduce overdose deaths?

(Posted August 2017)

State Prescription Drug Monitoring Programs and Fatal Drug Overdoses
Authors: Young Hee Nam, Dennis G. Shea, Yunfeng Shi, John R. Moran

Prescription drug overdoses have become one of the fastest growing and most serious public health concerns in the US. The number of fatal overdoses has increased from about 6,100 in 1980 to 47,055 in 2014 - almost 129 deaths per day.

Using US all-jurisdiction mortality data, estimated population data, and socio-demographic data from the CDC and the US Census Bureau, this study examined the impact of prescription drug monitoring programs (PDMPs) on drug overdose mortality rates across all drug categories from 1999 to 2014 and separately for each category from 1999 to 2010, including illicit drugs and other and unspecified drugs. The authors found that: (1) PDMPs, on average, have not been effective in reducing drug overdose mortality rates and (2) PDMPs may be associated with increased overdose mortality rates in drug categories other than prescription opioids. More comprehensive and prevention-oriented approaches may be needed to effectively reduce drug overdose deaths.

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Does P4P Improve Diabetes Care and Reimbursement in MA Star Program?

(Posted July 2017)

Value-Based Payments and Incentives to Improve Care: A Case Study of Patients with Type 2 Diabetes in Medicare Advantage
Authors: Jesse Sussell, Kata Bognar, Taylor T. Schwartz, Jason Shafrin, John J. Sheehan, Wade Aubry, Dennis Scanlon

Type 2 diabetes (T2D) affects approximately 1 in 10 patients in the US, with complications resulting in over $160 billion annual expenditures.
Pay-for-performance programs frequently measure the quality of care for patients with T2D. Interventions such as increased hemoglobin A1C monitoring and intensified medication to control A1C levels have resulted in improved clinical outcomes. However, their effects on plan-level quality ratings and reimbursement within the Medicare Advantage Star (MA Star) program are not clear. The goal of this study was to simulate how three interventions (i.e., improved A1C monitoring, treatment intensification for patients with poorly controlled A1C levels, and joint implementation of increased monitoring and treatment intensification) affect quality measures and reimbursement within the MA Star program.
The authors found that although plan-level initiatives to increase A1C control lead to better patient health outcomes, the average direct financial benefits for the MA Star plans appear to be small. Since using financial incentives to improve diabetes care is a valuable tool, current incentives may need to be revised.

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False-positive mammogram results linked to spike in new anxiety prescriptions

(Posted July 2017)

The Effect of False-positive Mammograms on Antidepressant and Anxiolytic Initiation
Authors: Joel Segel, Rajesh Balkrishnan, Richard Hirth

In a recent study that appeared in Medical Care, the authors found that when patients receive a false-positive mammogram result (a suspicious finding that is ultimately not a breast cancer diagnosis), they are more likely to begin a new prescription for anxiety or depression, compared to women who receive an initial negative result.

Furthermore, the study identifies particular sub-populations who may be at higher risk of initiating anxiety or depression medications following a false-positive mammogram, including those who receive multiple follow-up tests or for whom it takes longer than a week to resolve the false-positive. Because regular mammograms are key to early detection of breast cancer, the findings suggest that efforts to resolve initial positive results as quickly as possible, e.g., same-day follow-up tests, may help reduce anxiety and even prevent patients from starting anxiety or depression medication.

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Health Care’s Response to Sexual Assault in Underserved and Rural Communities

(Posted July 2017)

Dennis Scanlon and Sheridan Miyamoto discuss the new Sexual Assault Forensic Examination and Training (SAFE-T) Center, which will focus on improving access to quality forensic sexual assault care for adult and adolescent victims in underserved communities.

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Flipping the Traditional Medical School Training Model

(Posted May 2017)

Dennis Scanlon speaks with Jeffrey Wong, MD and Morgan Decker, Medical Student Design Partner to discuss an innovative medical education program at Penn State.

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Is there a relationship between immigrant generational status and the presence of developmental problems among prematurely born children?

(Posted May 2017)

Immigrant Generational Status and Developmental Problems among Prematurely Born Children
Authors: Bediako, P. T., BeLue, R., Hillemeier, M. M.

Immigrants in the U.S. often have comparatively favorable health outcomes despite relative socioeconomic disadvantage (i.e., the Immigrant Paradox phenomenon.) While Immigrant Paradox research shows that foreign-born status protects against preterm birth, less is known about the development of these children. Using the 2011-2012 National Survey of Children's Health, the authors examined the relationship between family immigrant status and developmental problems among preterm babies. Preterm 1st/2nd generation children had fewer developmental problems than preterm 3rd generation children. Controlling for socioeconomic status and other covariates, 1st/2nd generation children had significantly lower odds of developmental delay, cerebral palsy, epilepsy, and hearing problems.

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Causal Inference Methods for Evaluating Air Quality Policies

(Posted April 2017)

Corwin Zigler, PhD, Assistant Professor, Department of Biostatistics, Harvard T.H. Chan School of Public Health speaks in our Health Services Research Colloquium

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Valuing the Impact of Preventive Intervention Spending

(Posted April 2017)

A Framework for Valuing Investments in a Nurturing Society: Opportunities for Prevention Research
Authors: Daniel Max Crowley, PhD and Damon Jones, PhD

Investing in strategies to build a more nurturing society presents both opportunities and challenges to prevention scientists who work to go beyond effectiveness evaluations and actually value the impact of preventive strategies. In this study, the authors present a framework that values meaningful investments in children and youth, along with a new measurement strategy and cost of key services to assist when appealing to policymakers to make these investments.

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Health Policy in the Trump Era: Who Benefits?

(Posted April 2017)

Gerald Kominski, PhD, Professor, Department of Health Policy and Management, UCLA Fielding School of Public Health speaks in our Health Services Research Colloquium

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Ask the Experts Video Series - Making Cancer Care Patient-Centered

(Posted March 2017)

Dennis Scanlon speaks with Ray Hohl, MD, Director, Penn State Cancer Institute to discuss cancer care, including progress made in the field, making care “patient-centered,” and coordinating research efforts.

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Repeal of Affordable Care Act Facing Complex Challenge

(Posted January 2017)

The Altoona Mirror recently published an article about the Trump Administration's plan to quickly "repeal and replace" the Affordable Care Act. The article includes comments from Rep. Bill Shuster, R-9th District, Dr. Dennis Scanlon, and others. Scanlon spoke to the immediate larger problem of separating rumors from facts and determining realistic alternatives because the proclamation is short on details. More specifically he said that lifting the individual mandate would cause insurance premiums to continue to increase.

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Care Affordability and Out-of-Pocket Spending for Adults With Chronic Disease: What's the Difference between Low and High Deductible Plans?

(Posted January 2017)

Health Insurance Deductibles and Their Associations With Out-of-Pocket Spending and Affordability Barriers Among US Adults With Chronic Conditions
Authors: Joel Segel, PhD & Jeffrey Kullgren MD, MS, MPH

Using 2011-2013 data from the nationally representative Medical Expenditure Panel Survey, we compared associations between private health plan deductibles and out-of-pocket (OOP) spending, high medical cost burdens, and cost-related access barriers among nonelderly US adults with chronic conditions. We found higher deductibles were associated with significantly higher financial burden among the chronically ill. However, in contrast with prior findings, we did not find evidence that deductibles were associated with more reports of cost-related access barriers for individuals with chronic conditions. One reason may be that since cost-sharing has risen for all plan types, detecting differences between deductible levels could be more difficult. Nonetheless, as more privately insured Americans with chronic conditions face deductibles in employer sponsored and Marketplace health plans, it will be important to track their OOP spending, ability to afford care, and their health and financial outcomes.

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