The Influence of Short-Term Scoliosis-Specific Exercise Rehabilitation on Pulmonary Function in Patients with AIS.

OBJECTIVE: To investigate the short-term outcomes of treatment utilizing an outpatient scoliosis- specific back school program in thirty-six patients with adolescent idiopathic scoliosis (AIS). BACKGROUND: Improved signs and symptoms of AIS have been reported in response to curve-patternspecific exercise therapy programs. Additional outcome studies are needed. METHODS/MATERIALS: Thirty-six patients with adolescent idiopathic scoliosis (AIS), 33 females and 3 males, completed a twenty-hour multimodal exercise program (Schroth Best Practice® - SBP) for five to seven days at Scoliosis 3DC(SM). Average age was 13.89 years and average Cobb angles were 36.92° thoracic and 33.92° lumbar. The sample was comprised of patients under treatment from August 2011 to February 2015 who never had scoliosis-related surgery and who were not undergoing brace treatment. SBP program components included physio-logic® exercises, mobilizations, activities of daily living (ADLs), 3-D Made Easy®, and Schroth exercises. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), chest expansion (CE), and angle of trunk rotation (ATR) were clinical parameters used to evaluate results of this outpatient scoliosis-specific exercise program. RESULTS: Highly significant improvements were noted in FVC, FEV1, CE and Scoliometer(TM) readings. CONCLUSIONS: A short-term outpatient SBP program was found to have a positive influence on FVC, FEV1, ATR, and CE. We will present long-term results in a subsequent study.

Understanding variations in Medicare Consumer Assessment of Health Care Providers and Systems scores: California as an example.

OBJECTIVE: To understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiaries, and variation across MA plans within California. STUDY DESIGN/DATA COLLECTION: Using 2008 CAHPS survey data for fee-for-service Medicare beneficiaries and MA members, we compared mean case mix adjusted Medicare CAHPS scores for California and the remainder of the nation. PRINCIPAL FINDINGS: California fee-for-service Medicare had lower scores than non-California fee-for-service on 11 of 14 CAHPS measures; California MA had lower scores only for physician services measures and higher scores for other measures. Adding race/ethnicity and urbanity to risk adjustment improved California standing for all measures in both MA and fee-for-service. Within the MA plans, one large plan accounted for the positive performance in California MA; other California plans performed below national averages. CONCLUSIONS: This study shows that the mix of fee-for-service and MA enrollees, demographic characteristics of populations, and plan-specific factors can all play a role in observed regional variations. Anticipating value-based payments, further study of successful MA plans could generate lessons for enhancing patient experience for the Medicare population.

Patient activation status as a predictor of patient experience among Medicare beneficiaries.

BACKGROUND: Patient activation status (PAS) can be identified using the Medicare Segmentation Screening Tool, a 2-item measure assessing patients' health skills and motivation to participate in their own care. OBJECTIVE: To determine whether PAS is predictive of Medicare beneficiary health care experiences with health providers and insurance plans after case-mix adjustment. RESEARCH DESIGN: Linear regression models examined the association between PAS and evaluations of care after case-mix adjustment in observational cross-sectional data. SUBJECTS: 236,322 Medicare beneficiaries with at least one prescription medication responding to the Medicare Segmentation Screening Tool items on the 2007 Medicare Consumer Assessment of Healthcare Providers and Systems Survey. MEASURES: Four-category patient activation category; 11 patient-reported evaluations of health care and providers and 2 self-reported immunization measures. RESULTS: PAS was strongly predictive of beneficiary experience beyond case-mix adjustment. Even after case-mix adjustment, active beneficiaries consistently reported the most positive experiences, followed by complacent beneficiaries, with differences of 0.2 to 0.4 standard deviations for 4 of 5 composite measures of patient experience (P < 0.05). Adjusted immunization rates for flu and pneumonia were highest for active beneficiaries, followed closely by high-effort beneficiaries. The rates for these 2 segments were 10 percentage points higher than for complacent and passive beneficiaries. CONCLUSIONS: PAS may be an important determinant of health care experiences. More confident respondents (active and complacent) give higher ratings of their care and providers, suggesting that they have more favorable experiences. Respondent motivation (high for active and high effort) seems to be a factor in receiving preventive care.

Psychometric properties of an instrument to assess Medicare beneficiaries' prescription drug plan experiences.

Using data from 335,249 Medicare beneficiaries who responded to the 2007 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, along with data from 22 cognitive interviews, we investigated the reliability and validity of an instrument designed to assess beneficiaries' experiences with their prescription drug plans. Composite measures derived from the instrument had acceptable internal consistency and sufficient plan-level reliability to inform consumer choice, quality improvement, and payor oversight. These measures were positively associated with members' overall rating of the plan and their willingness to recommend the plan. Moreover, each was independently useful in predicting beneficiaries' global ratings of their plan. This instrument can be an important tool for helping beneficiaries to choose a plan that best meets their needs.

Market and beneficiary characteristics associated with enrollment in Medicare managed care plans and fee-for-service.

BACKGROUND: Risk selection in the Medicare managed care program ("Medicare Advantage") is an important policy concern. Past research has shown that Medicare managed care plans tend to attract healthier beneficiaries and that market characteristics such as managed care penetration may also affect risk selection. OBJECTIVES: To assess whether patient enrollment in Medicare managed care (MMC) or traditional fee-for-service (FFS) Medicare is related to beneficiary and market characteristics and provide a baseline for understanding how changes in Medicare policy affect MMC enrollment over time. RESEARCH DESIGN: Data sources were the 2004 Medicare MMC and FFS CAHPS surveys, the Social Security Administration's Master Beneficiary Record, MMC Market Penetration Files, and 2000 Census data. We estimated logistic regression models to assess what beneficiary characteristics predict enrollment in MMC and the moderating effects of market characteristics. RESULTS: Enrollees in MMC plans tend to have better health than those in FFS. This effect is weaker in areas with more competition. Latinos and beneficiaries with less education and lower income, as indicated by earnings history or local-area median income, are more likely to enroll in MMC. CONCLUSIONS: Enrollment in MMC is related to beneficiary characteristics, including health status and socioeconomic status, and is modified by MMC presence in the local market. Because vulnerable subgroups are more likely to enroll in MMC plans, the Centers for Medicare & Medicaid Services should monitor how changes to Medicare Advantage policies and payment methods may affect beneficiaries in those groups.

Voluntary disenrollment from Medicare advantage plans: valuable signals of market performance.

OBJECTIVE: To examine 2000-2005 trends in the reasons Medicare beneficiaries gave for disenrolling from their Medicare Advantage (MA) plans. STUDY DESIGN: We used data from 6 consecutive years of Consumer Assessment of Health Plans surveys, which asked about 33 possible reasons for disenrollment, including problems with plan information, out-of-pocket costs, plan benefits, and coverage. Respondents numbered more than 50,000 beneficiaries each year from a variety of MA plan types providing full Medicare benefits in place of traditional fee-for-service Medicare. The survey also collected demographic and health status information. METHODS: We classified reasons for disenrollment into 2 key groups: (1) reasons related to plan information and (2) reasons related to cost/benefits problems. We examined whether disparities existed between vulnerable and less vulnerable populations that might reflect different experiences by these groups over time. RESULTS: Disparities between vulnerable and less vulnerable groups were present but generally diminished over time as competition intensified, with noticeable differences between African American and Hispanic subpopulations regarding problems with plan information. CONCLUSIONS: The premise of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 was that more plans would increase competition, resulting in higher-quality healthcare services. However, an increased number of plan choices complicates the health plan decision-making process for beneficiaries. With further expansion of plans and choices following implementation of Part D, efforts must continue to direct informational materials to all beneficiaries, particularly those in vulnerable subgroups. More help in interpreting the information may be required to maximize consumer benefits.

Voluntary disenrollment from Medicare managed care: market factors and disabled beneficiaries.

Disenrollment rates from Medicare managed care plans have been reported to the public as an indicator of health plan quality. Previous studies have shown that voluntary disenrollment rates differ among vulnerable subgroups, and that these rates can reflect patient care experiences. We hypothesized that disabled beneficiaries may be affected differently than other beneficiaries by competitive market factors, due to higher expected expenditures and impaired mobility. Findings suggest that disabled beneficiaries are more likely to experience multiple problems with managed care.

Financial vulnerability among Medicare managed care enrollees.

Consumer Assessment of Health Plans Survey (CAHPS) data show that Medicare managed care plans often receive low satisfaction scores from certain vulnerable populations. This article describes findings from a qualitative study with beneficiaries about their Medicare managed care experiences. Focus groups were stratified by participant race/ethnicity and self-described health status. Yet participants did not describe their concerns in terms of their race, ethnicity, or health condition, but rather their access to financial resources. Our findings suggest that researchers consider how socioeconomics creates health care vulnerability for racial and ethnic minorities, females, people with disabilities, and other economically marginalized persons.

Medicare Managed Care CAHPS®: A Tool for Performance Improvement.

The Medicare+Choice (M+C) program, created by the 1997 Balanced Budget Act (BBA), expands Medicare's health insurance options to include a wider range of health plan options. In this article, we describe the Consumer Assessment of Health Plans Study (CAHPS®) survey and its use with beneficiaries receiving care through Medicare managed care (MMC) plans. We also discuss the implications of these efforts for future quality improvement efforts.