Consumer Purchasing Patterns in Response to Calorie Labeling Legislation in NYC
International Journal of Behavioral Nutrition and Physical Activity. In Press.
Maya Vadiveloo, L. Beth Dixon and Brian Elbel.
Current Risk Management Issues for Hazardous Liquids and Natural Gas Pipeline Infrastructure
J.S. Simonoff, C.E. Restrepo, and R. Zimmerman.
Climate Change and Human Health in Cities
in Urban Climate Change Research Network (UCCRN), First UCCRN Assessment Report on Climate Change in Cities (ARC3), edited by C. Rosenzweig, W. D. Solecki, S. A. Hammer, and S. Mehrotra. New York, NY: Cambridge University Press, 2011, forthcoming, pp. 183-217
M. Barata (Rio de Janeiro), E. Ligeti (Toronto), Coordinating Lead Authors and G. De Simone (Rio de Janeiro), T. Dickinson (Toronto), D. Jack (New York City), J. Penney (Toronto), M. Rahman (Dhaka), and R. Zimmerman (New York City.)
Health and Social Service Expenditures: Associations with Health Outcomes
BMJ - Quality and Safety. Mar 29 epub, In Press.
Elizabeth Bradley, Benjamin Elkins, Jeph Herrin and Brian Elbel.
Objective To examine variations in health service expenditures and social services expenditures across Organisation for Economic Co-operation and Development (OECD) countries and assess their association with five population-level health outcomes.
Design A pooled, cross-sectional analysis using data from the 2009 release of the OECD Health Data 2009 Statistics and Indicators and OECD Social Expenditure Database.
Setting OECD countries (n=30) from 1995 to 2005.
Main outcomes Life expectancy at birth, infant mortality, low birth weight, maternal mortality and potential years of life lost.
Results Health services expenditures adjusted for gross domestic product (GDP) per capita were significantly associated with better health outcomes in only two of five health indicators; social services expenditures adjusted for GDP were significantly associated with better health outcomes in three of five indicators. The ratio of social expenditures to health expenditures was significantly associated with better outcomes in infant mortality, life expectancy and increased potential life years lost, after adjusting for the level of health expenditures and GDP.
Conclusion Attention to broader domains of social policy may be helpful in accomplishing improvements in health envisioned by advocates of healthcare reform.
"Health Insurance and Health Policy, American and Japanese Style: Lessons of Comparative Experience"
Japan and the World Economy, (5)2, Summer 1993.
Transportation to Clinic: Findings from a Pilot Clinic-Based Survey of Low-Income Suburbanites
Journal of Immigrant and Minority Health 2010. DOI: 10.1007/s10903-010-9410-0
Silver D, J Blustein, BC Weitzman.
Health care policymakers have cited transportation barriers as key obstacles to providing health care to low-income suburbanites, particularly because suburbs have become home to a growing number of recent immigrants who are less likely to own cars than their neighbors. In a suburb of New York City, we conducted a pilot survey of low income, largely immigrant clients in four public clinics, to find out how much transportation difficulties limit their access to primary care. Clients were receptive to the opportunity to participate in the survey (response rate = 94%). Nearly one-quarter reported having transportation problems that had caused them to miss or reschedule a clinic appointment in the past. Difficulties included limited and unreliable local bus service, and a tenuous connection to a car. Our pilot work suggests that this population is willing to participate in a survey on this topic. Further, since even among those attending clinic there was significant evidence of past transportation problems, it suggests that a population based survey would yield information about substantial transportation barriers to health care.
Massachusetts Links Pay for Performance to the Reduction of Racial and Ethnic Disparities
Health Affairs. 30(6):1165-1175.
Blustein, Jan, Joel Weissman, Andrew M Ryan, Tim Doran and Romana Hasnain-Wynia.
The Institute of Medicaid has identified equity as a key dimension of quality. Recently, Massachusetts’ Medicaid program (MassHealth) took the unusual step of linking pay-for-performance (P4P) to the reduction of racial/ethnic disparities for hospital care. We report on early experience with the program, describing the challenges of implementing an ambitious program in a short time frame, with limited resources. Our findings raise questions about whether P4P as currently constituted is a suitable tool for addressing disparities in hospital care.
Geographic Variations in Health Care Workforce Training in the US: The Case of Registered Nurses (RNs)
Med Care. 2011 Aug;49(8):769-74.
Background: In the United States, registered nurses [RNs] are trained through one of three educational pathways: a diploma course; an associate's degree, or a baccalaureate degree in nursing (the BSN). A national consensus has emerged that the proportion of RNs that are baccalaureate-trained should be substantially increased. Yet achieving that goal may be difficult in areas where college graduates are unlikely to reside.
Objectives: To determine whether the level of training of the hospital registered nurse [RN] workforce varies geographically, along with the education of the local general workforce.
Research design: Cross sectional, ecological study.
Subjects: Hospital nurses who participated in the National Sample Survey of Registered Nurses [NSSRN] in 2004 (n = 16,567).
Measures. Registered Nurse training was measured as Diploma, Associates degree, or Baccalaureate degree or above. County-level general workforce quality was assessed as the adult college graduation rate. Counties were divided into US population quartiles, with the highest quartile (Q4) having more than 29.3% college graduates, and the lowest quartile (Q1) having fewer than 16.93% college graduates.
Results: Hospital RNs have a higher level of training in counties where the general population is better
educated. For example, in Q4, 55.2% of hospital RNs are baccalaureate-trained, in Q3, 50.2%; in Q2,45.2%; and in Q1, 34.9% (p < .001 for all pairwise comparisons). The association between RN training and general workforce education is found in cities, towns and rural areas.
Conclusions: Nationwide, there are substantial geographic variations in the training of hospital RNs. Educational segregation (the tendency for educated people to cluster geographically) may make it more difficult to achieve a BSN-rich nursing workforce in some areas of the US. Further work is needed to assess whether educational segregation similarly influences the distribution of other health care professionals, and whether it leads to variations in the local quality of care.
Six Countries, Six Reform Models: The healthcare reform experience of Israel, The Netherlands, New Zealand, Singapore, Switzerland and Taiwan: Healthcare Reforms "Under the Radar Screen"
JAMA. 2010; Vol. 304, No. 18: 2,070-2,071
The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality
Health Services Research. 2011:46(3);712-728
Ryan, Andrew M and Jan Blustein.
Objective. To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data. Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N=62) and other states (N=3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design. Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings. Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (-0.67 percentage points, p>.10) and SIP (-0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions. Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation.
Impact of employment-based health insurance on home attendants.
Journal of Health Care for the Poor and Underserved, 4, 374-385.
Weitzman, B.C. and Berry, C.A.
A la santé de l'oncle Sam: regards croisés sur les systémes de santé; américain et français (To Uncle Sam's Health: Cross perspectives on the American and French Health Systems)
Tabuteau, D., Rodwin, V.G.
Victor Rodwin, professor of health policy and management at NYU Wagner, and his colleague Didier Tabuteau, counselor of state and professor of health policy at the Institut d'Etudes Politiques and the University of Paris Descartes, have published a new book (published by Editions Jacob Duvernet) in which they challenge the conventional wisdom that the French health care system is a government-managed, public and collective enterprise and the American system a private, market-oriented and individualist system. Based on six months of debates in Paris while Professor Rodwin held the Fulbright-Toqueville Chair (spring semester, 2010), this book compares public health, health insurance, the power of physicians, health care reform, and the silent revolution that is transforming health care organization in both France and the United States.
A Philanthropy Tackles Growth In Health Costs At The State Level
Health Affairs, 29, no. 7 (2010): 1411-1414
Sandman, D., & Kovner, A.
Slowing the rate of growth of health spending is as critical a goal at the state level as it is at the national level. Philanthropy can hardly address this issue alone, yet it has an obligation to take on big and seemingly intractable problems. The New York State Health Foundation is committed to stimulating innovative and replicable approaches to bending the cost curve.
This article describes how the foundation recently awarded six grants to support efforts related to payment reform, hospital re-admissions, medical malpractice reform, palliative care, and the quantification of other cost containment approaches that could be pursued atthe state level.
Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study
PLoS Med 7(6): e1000297. doi:10.1371/journal.pmed.1000297
Blustein, J., Borden, W.B., Valentine, M.
Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and
improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.
Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’ program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement.
Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.
Please see later in the article for the Editors’ Summary.
Evidence-Based Management in Healthcare
Chicago:Health Administration Press
A.R Kovner, R. D'Aquila, D Fine
Too often in the fast-moving healthcare field, decision makers rely primarily on what has worked before. Evidence-Based Management in Healthcare explains how healthcare leaders can move from making educated guesses to using the best available information to make decisions.
Medicare Payments, Health Care Services Use, and Telemedicine Implementation Cost in Randomized Trial Comparing Telemedicine Case Management With Usual Care in Medically Underserved Patients With Diabetes Mellitus
Journal of the American Medical Informatics Association
Palmas, W., Shea, S., Starren, J., Teresi, J.E., Ganz, M.L., Burton, T.M., Pashos, C.L., Blustein, J., Field, L., Morin, P.C., Izquierdo, R.E., Silver, S., Eimicke, J.P., Langiua, R.A. & Weinstock, S.
To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention.
We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine case management of diabetes to usual care. Participants were aged 55 years or older, and resided in federally designated medically underserved areas of New York State.
We analyzed Medicare claims payments for each participant for up to 60 study months from date of randomization, until their death, or until December 31, 2006 (whichever happened first). We also analyzed study expenditures for the telemedicine intervention over six budget years (February 28, 2000- February 27, 2006).
Mean annual Medicare payments (SE) were similar in the usual care and telemedicine groups, $9040 ($386) and $9669 ($443) per participant, respectively (p>0.05). Sensitivity analyses, including stratification by censored status, adjustment by enrollment site, and semi-parametric weighting by probability of dropping-out, rendered similar results. Over six budget years 28 821 participant/months of telemedicine intervention were delivered, at an estimated cost of $622 per participant/month.
Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population. The cost of implementing the telemedicine intervention was high, largely representing special purpose hardware and software costs required at the time. Lower implementation costs will need to be achieved using lower cost technology in order for telemedicine case management to be more widely used.
Urban Aging, Social Isolation, and Emergency Preparedness
IFA Global Ageing
Gusmano, M.K & Rodwin, V.G.
La Révolution Tranquille du Managed Care aux Etats Unis. (The Silent Revolution of Managed Care in the United States)
Ch. 21 in Tabuteau, D. Bras, P.L. and de Pouvourville, G., eds. Traité d’Economie et de Gestion de la Santé. Paris. Presses de Sciences Politiques
Leveraging Technology to Educate New Healthcare IT Leaders
Journal of Healthcare Infomation Management
The increasing need to educate healthcare IT leaders will require the use of other educational methods in addition to classroom instruction, seminars at conferences and webinars. The author has 12 years experience offering a "blended" course on healthcare IT for managers and clinicians in an MBA program. The course combines face-to-face classroom instruction with on-line discussion. This reduces the time away from work and travel required. But it has far greater benefits, including the development of a capacity to analyze situations and develop and defen solutions. Participants share knowledge and begin to grasp the differences in their environments that require attention. This method is compared with other teaching methods and its advantages are explained.
Strangers in a Strange Land: Recent Entrants to the U.S. Confront the Culture of Medical Consumerism
Schlesinger, M., Calderas, O. & Elbel, B.