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1.
BMJ Open ; 14(4): e072441, 2024 Apr 03.
Article in English | MEDLINE | ID: mdl-38569678

ABSTRACT

OBJECTIVE: Assessing excess deaths from benchmarks across causes of death during the first wave of the COVID-19 pandemic and identifying morbidities most frequently mentioned alongside COVID-19 deaths in the death record. METHODS: Descriptive study of death records between 11 March 2020 and 27 July 2020, from the New York City Bureau of Vital Statistics. Mortality counts and percentages were compared with the average for the same calendar period of the previous 2 years. Distributions of morbidities from among forty categories of conditions were generated citywide and by sex, race/ethnicity and four age groups. Causes of death were assumed to follow Poisson processes for Z-score construction. RESULTS: Within the study period, 46 563 all-cause deaths were reported; 132.9% higher than the average for the same period of the previous 2 years (19 989). Of those 46 563 records, 19 789 (42.5%) report COVID-19 as underlying cause of death. COVID-19 was the most prevalent cause across all demographics, with respiratory conditions (prominently pneumonia), hypertension and diabetes frequently mentioned morbidities. Black non-Hispanics had greater proportions of mentions of pneumonia, hypertension, and diabetes. Hispanics had the largest proportion of COVID-19 deaths (52.9%). Non-COVID-19 excess deaths relative to the previous 2-year averages were widely reported. CONCLUSION: Mortality directly due to COVID-19 was accompanied by significant increases across most other causes from their reference averages, potentially suggesting a sizable COVID-19 death undercount. Indirect effects due to COVID-19 may partially account for some increases, but findings are hardly dispositive. Unavailability of vaccines for the time period precludes any impact over excess deaths. Respiratory and cardiometabolic-related conditions were most frequently reported among COVID-19 deaths across demographic characteristics.


Subject(s)
COVID-19 , Diabetes Mellitus , Hypertension , Pneumonia , Humans , Cause of Death , Pandemics , Death Certificates , New York City/epidemiology , Pneumonia/epidemiology , Morbidity , Diabetes Mellitus/epidemiology
2.
J Acquir Immune Defic Syndr ; 91(5): 434-438, 2022 12 15.
Article in English | MEDLINE | ID: mdl-36084201

ABSTRACT

OBJECTIVE: To conduct a population-based analysis and compare life expectancy between people with HIV and the general population in New York City (NYC). METHODS: We obtained the annual total number and age, sex, and race/ethnicity distributions of people with HIV from the NYC HIV registry and generated comparable numbers for the NYC general population from the Census 2000 and 2010 data using linear interpolation. RESULTS: Life expectancy at age 20 among people with HIV increased from 38.5 years [95% confidence interval (CI): 37.4 to 39.5] in 2009 to 50.6 (95% CI: 48.5 to 52.7) in 2018, whereas it increased from 62.0 years (95% CI: 61.8 to 62.1) to 63.6 (95% CI: 63.5 to 63.7) among the NYC general population. The gap between the 2 populations narrowed from 23.5 years (95% CI: 22.4 to 24.6) in 2009 to 13.0 (95% CI: 10.9 to 15.1) in 2018. By sex and race/ethnicity, life expectancy at age 20 among people with HIV increased from 36.7 years in 2009 to 47.9 in 2018 among Black men; 37.5 to 50.5 years among Black women; 38.6 to 48.9 years among Hispanic men; 46.0 to 51.0 years among Hispanic women; 44.7 to 59.7 years among White men; and 38.0 years in 2009-2013 to 50.4 years in 2014-2018 among White women. CONCLUSIONS: Life expectancy among people with HIV improved greatly in NYC in 2009-2018, but the improvement was not equal across sex and racial/ethnic groups. The gap in life expectancy between people with HIV and the general population narrowed but remained.


Subject(s)
HIV Infections , Male , Humans , Female , Young Adult , Adult , New York City/epidemiology , HIV Infections/epidemiology , Life Expectancy , Ethnicity , Racial Groups
3.
Am J Public Health ; 110(7): 1046-1053, 2020 07.
Article in English | MEDLINE | ID: mdl-32437270

ABSTRACT

Objectives. To assess if historical redlining, the US government's 1930s racially discriminatory grading of neighborhoods' mortgage credit-worthiness, implemented via the federally sponsored Home Owners' Loan Corporation (HOLC) color-coded maps, is associated with contemporary risk of preterm birth (< 37 weeks gestation).Methods. We analyzed 2013-2017 birth certificate data for all singleton births in New York City (n = 528 096) linked by maternal residence at time of birth to (1) HOLC grade and (2) current census tract social characteristics.Results. The proportion of preterm births ranged from 5.0% in grade A ("best"-green) to 7.3% in grade D ("hazardous"-red). The odds ratio for HOLC grade D versus A equaled 1.6 and remained significant (1.2; P < .05) in multilevel models adjusted for maternal sociodemographic characteristics and current census tract poverty, but was 1.07 (95% confidence interval = 0.92, 1.20) after adjustment for current census tract racialized economic segregation.Conclusions. Historical redlining may be a structural determinant of present-day risk of preterm birth.Public Health Implications. Policies for fair housing, economic development, and health equity should consider historical redlining's impacts on present-day residential segregation and health outcomes.


Subject(s)
Housing/statistics & numerical data , Premature Birth/epidemiology , Racism , Social Segregation , Female , Humans , Infant, Newborn , New York City/epidemiology , Poverty , Pregnancy , Residence Characteristics/classification
4.
Open Forum Infect Dis ; 5(2): ofy020, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29955618

ABSTRACT

BACKGROUND: "Pneumonia and influenza" are the third leading cause of death in New York City. Since 2012, pneumonia and influenza have been the only infectious diseases listed among the 10 leading causes of death in NYC. Most pneumonia and influenza deaths in NYC list pneumonia as the underlying cause of death, not influenza. We therefore analyzed death certificate data for pneumonia in NYC during 1999-2015. METHODS: We calculated annualized pneumonia death rates (overall and by sociodemographic subgroup) and examined the etiologic agent listed. RESULTS: There were 41 400 pneumonia deaths during the study period, corresponding to an annualized age-adjusted death rate of 29.7 per 100 000 population. Approximately 17.5% of pneumonia deaths specified an etiologic agent. Age-adjusted pneumonia death rate declined over the study period and across each borough. Males had an annualized age-adjusted pneumonia death rate 1.5 (95% confidence interval [CI], 1.5-1.5) times that of females. Non-Hispanic blacks had an annualized age-adjusted pneumonia death rate 1.2 (95% CI, 1.2-1.2) times that of non-Hispanic whites. The annualized pneumonia death rate increased with age group above 5-24 years and neighborhood-level poverty. Staten Island had an annualized age-adjusted pneumonia death rate 1.3 (95% CI, 1.2-1.3) times that of Manhattan. In the multivariable analysis, pneumonia deaths were more likely to occur among males, non-Hispanic blacks, persons aged ≥65 years, residents of neighborhoods with higher poverty levels, and in Staten Island. CONCLUSIONS: While the accuracy of death certificates is unknown, investigation is needed to understand why certain populations are disproportionately recorded as dying from pneumonia in NYC.

5.
J Urban Health ; 94(5): 746-755, 2017 10.
Article in English | MEDLINE | ID: mdl-28623451

ABSTRACT

Deaths attributable to hepatitis C (HCV) infection are increasing in the USA even as highly effective treatments become available. Neighborhood-level inequalities create barriers to care and treatment for many vulnerable populations. We seek to characterize citywide trends in HCV mortality rates over time and identify and describe neighborhoods in New York City (NYC) with disproportionately high rates and associated factors. We used a multiple cause of death (MCOD) definition for HCV mortality. Cases identified between January 1, 2006, and December 31, 2014, were geocoded to NYC census tracts (CT). We calculated age-adjusted HCV mortality rates and identified spatial clustering using a local Moran's I test. Temporal trends were analyzed using joinpoint regression. A multistep global and local Poisson modeling approach was used to test for neighborhood associations with sociodemographic indicators. During the study period, 3697 HCV-related deaths occurred in NYC, with an average annual percent increase of 2.6% (p = 0.02). The HCV mortality rates ranged from 0 to 373.6 per 100,000 by CT, and cluster analysis identified significant clustering of HCV mortality (I = 0.23). Regression identified positive associations between HCV mortality and the proportion of non-Hispanic black or Hispanic residents, neighborhood poverty, education, and non-English-speaking households. Local regression estimates identified spatially varying patterns in these associations. The rates of HCV mortality in NYC are increasing and vary by neighborhood. HCV mortality is associated with many indicators of geographic inequality. Results identified neighborhoods in greatest need for place-based interventions to address social determinants that may perpetuate inequalities in HCV mortality.


Subject(s)
Hepatitis C/mortality , Residence Characteristics/statistics & numerical data , Socioeconomic Factors , Adult , Aged , Aged, 80 and over , Censuses , Female , Health Status Disparities , Hepatitis C, Chronic/mortality , Humans , Liver Cirrhosis, Alcoholic/mortality , Liver Neoplasms/mortality , Male , Middle Aged , New York City/epidemiology , Poverty , Regression Analysis , Spatio-Temporal Analysis
6.
Pediatrics ; 137(4)2016 04.
Article in English | MEDLINE | ID: mdl-26933212

ABSTRACT

BACKGROUND: Neonatal infection with herpes simplex virus (HSV) is not a nationally reportable disease; there have been few population-based measures of HSV-related infant mortality. We describe infant death rates due to neonatal HSV as compared with congenital syphilis (CS) and HIV, 2 reportable, perinatally transmitted diseases, in New York City from 1981 to 2013. METHODS: We identified neonatal HSV-, CS-, and HIV-related deaths using International Classification of Diseases (ICD) codes listed on certificates of death or stillbirth issued in New York City. Deaths were classified as HSV-related if certificates listed (1) any HSV ICD-9/ICD-10 codes for deaths ≤42 days of age, (2) any HSV ICD-9/ICD-10 codes and an ICD code for perinatal infection for deaths at 43 to 365 days of age, or (3) an ICD-10 code for congenital HSV. CS- and HIV-related deaths were those listing any ICD code for syphilis or HIV. RESULTS: There were 34 deaths due to neonatal HSV (0.82 deaths per 100 000 live births), 38 from CS (0.92 per 100 000), and 262 from HIV (6.33 per 100 000). There were no CS-related deaths after 1996, and only 1 HIV-related infant death after 2004. The neonatal HSV-related death rate during the most recent decade (2004-2013) was significantly higher than in previous years. CONCLUSIONS: The increasing neonatal HSV-related death rate may reflect increases in neonatal herpes incidence; an increasing number of pregnant women have never had HSV type 1 and are therefore at risk of acquiring infection during pregnancy and transmitting to their infant.


Subject(s)
HIV Infections/mortality , HIV-1 , Herpes Simplex/mortality , Infant Death , Simplexvirus , Syphilis, Congenital/mortality , Female , HIV Infections/diagnosis , HIV Infections/transmission , Herpes Simplex/diagnosis , Herpes Simplex/transmission , Humans , Infant , Infant Death/prevention & control , Infant, Newborn , Infectious Disease Transmission, Vertical/statistics & numerical data , Male , New York City/epidemiology , Pregnancy , Syphilis, Congenital/diagnosis , Syphilis, Congenital/transmission
7.
PLoS One ; 11(2): e0149015, 2016.
Article in English | MEDLINE | ID: mdl-26882207

ABSTRACT

BACKGROUND: Ischemic heart disease (IHD) mortality has been on the decline in the United States for decades. However, declines in IHD mortality have been slower in certain groups, including young women and black individuals. HYPOTHESIS: Trends in IHD vary by age, sex, and race in New York City (NYC). Young female minorities are a vulnerable group that may warrant renewed efforts to reduce IHD. METHODS: IHD mortality trends were assessed in NYC 1980-2008. NYC Vital Statistics data were obtained for analysis. Age-specific IHD mortality rates and confidence bounds were estimated. Trends in IHD mortality were compared by age and race/ethnicity using linear regression of log-transformed mortality rates. Rates and trends in IHD mortality rates were compared between subgroups defined by age, sex and race/ethnicity. RESULTS: The decline in IHD mortality rates slowed in 1999 among individuals aged 35-54 years but not ≥55. IHD mortality rates were higher among young men than women age 35-54, but annual declines in IHD mortality were slower for women. Black women age 35-54 had higher IHD mortality rates and slower declines in IHD mortality than women of other race/ethnicity groups. IHD mortality trends were similar in black and white men age 35-54. CONCLUSIONS: The decline in IHD mortality rates has slowed in recent years among younger, but not older, individuals in NYC. There was an association between sex and race/ethnicity on IHD mortality rates and trends. Young black women may benefit from targeted medical and public health interventions to reduce IHD mortality.


Subject(s)
Black or African American , Myocardial Ischemia/mortality , Registries , Adult , Age Distribution , Age Factors , Asian People , Female , Hispanic or Latino , Humans , Linear Models , Male , Middle Aged , Mortality, Premature/ethnology , Mortality, Premature/trends , Myocardial Ischemia/epidemiology , Myocardial Ischemia/ethnology , New York City/epidemiology , New York City/ethnology , Sex Distribution , Sex Factors , White People
8.
J Public Health Manag Pract ; 22(3): 255-64, 2016.
Article in English | MEDLINE | ID: mdl-25887941

ABSTRACT

OBJECTIVE: New York City's (NYC's) life expectancy gains have been greater than those seen nationally. We examined life-expectancy changes over the past decade in selected NYC subpopulations and explored which age groups and causes of death contributed most to the increases. METHODS: We calculated life expectancy with 95% confidence intervals (CIs) for 2001-2010 by sex and race/ethnicity. Life expectancy was decomposed by age group and cause of death. Logistic regressions were conducted to reinforce the results from decomposition by controlling confounders. RESULTS: Overall, NYC residents' life expectancy at birth increased from 77.9 years (95% CI, 77.8-78.0) in 2001 to 80.9 years (95% CI, 80.8-81.0) in 2010. Decreases in deaths from heart disease, cancer, and HIV disease accounted for 50%, 16%, and 11%, respectively, of the gains. Decreased mortality in older age groups (≥65 years) accounted for 45.6% of the overall change. CONCLUSIONS: Life expectancy increased for both sexes, across all racial/ethnic groups, and for both the US-born and the foreign-born. Disparities in life expectancy decreased as overall life expectancy increased. Decreased mortality among older adults and from heart disease, cancer, and HIV infection accounted for most of the increases.


Subject(s)
Life Expectancy/trends , Adolescent , Adult , Aged , Aged, 80 and over , Cause of Death , Child , Child, Preschool , Emigrants and Immigrants , Ethnicity , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , New York City/epidemiology , Racial Groups , Risk Factors , Sex Distribution , Young Adult
9.
Am J Public Health ; 106(2): 256-63, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26691119

ABSTRACT

OBJECTIVES: We evaluated use of the Index of Concentration at the Extremes (ICE) for public health monitoring. METHODS: We used New York City data centered around 2010 to assess cross-sectional associations at the census tract and community district levels, for (1) diverse ICE measures plus the US poverty rate, with (2) infant mortality, premature mortality (before age 65 years), and diabetes mortality. RESULTS: Point estimates for rate ratios were consistently greatest for the novel ICE that jointly measured extreme concentrations of income and race/ethnicity. For example, the census tract-level rate ratio for infant mortality comparing the bottom versus top quintile for an ICE contrasting low-income Black versus high-income White equaled 2.93 (95% confidence interval [CI] = 2.11, 4.09), but was 2.19 (95% CI = 1.59, 3.02) for low versus high income, 2.77 (95% CI = 2.02, 3.81) for Black versus White, and 1.56 (95% CI = 1.19, 2.04) for census tracts with greater than or equal to 30% versus less than 10% below poverty. CONCLUSIONS: The ICE may be a useful metric for public health monitoring, as it simultaneously captures extremes of privilege and deprivation and can jointly measure economic and racial/ethnic segregation.


Subject(s)
Demography/statistics & numerical data , Public Health/methods , Adult , Cross-Sectional Studies , Ethnicity , Healthcare Disparities/ethnology , Humans , Infant , Infant Mortality , Mortality, Premature , New York City/epidemiology , Poverty/ethnology , Poverty/statistics & numerical data , Racial Groups , Socioeconomic Factors
10.
Clin Cardiol ; 38(2): 114-20, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25716311

ABSTRACT

BACKGROUND: Over the past decade, ischemic heart disease (IHD) mortality trends have been less favorable among adults age 25-54 than age ≥55 years. HYPOTHESIS: Disorders associated with IHD such as diabetes, chronic inflammatory and infectious diseases, and cocaine use are important contributors to premature IHD mortality. METHODS: Multiple-cause-of-death analysis was performed using the New York City (NYC) Vital Statistics database. Frequencies of selected contributing causes on death records with IHD as the underlying cause for decedents age ≥25 were assessed (n = 418,151; 1990-2008). Concurrent Telephone risk-factor surveys (NYC Community Health Survey, Centers for Disease Control Behavioral Risk Factor Survey in New York State) were analyzed. RESULTS: In sum, a prespecified contributing cause was identified on 13.6% of death certificates for IHD decedents age 25-54. Diabetes was reported more frequently for younger IHD decedents (15% of females and 10% of males age 25-54 vs 6% of both sexes age ≥ 55). In contrast, concurrent diabetes prevalence in New York State was 3.4% for those age 25-54 and 13.6% for those age >55 (P < 0.0001). Systemic lupus erythematosus, human immunodeficiency virus, and cocaine were also more likely to contribute to IHD death among younger than older people. CONCLUSIONS: Diabetes may be a potent risk factor for IHD death in young people, particularly young women, in whom it was reported on IHD death records at a rate 5× higher than local prevalence. The high frequency of reporting of studied contributing causes in younger IHD decedents may provide a focus for further IHD mortality-reduction efforts in younger adults.


Subject(s)
Diabetes Mellitus/mortality , Myocardial Ischemia/mortality , Adult , Age Distribution , Age Factors , Cause of Death , Comorbidity , Databases, Factual , Diabetes Mellitus/diagnosis , Female , Humans , Male , Middle Aged , Myocardial Ischemia/diagnosis , New York City/epidemiology , Prevalence , Risk Assessment , Risk Factors , Sex Distribution , Sex Factors , Time Factors
11.
Prev Chronic Dis ; 10: E77, 2013 May 16.
Article in English | MEDLINE | ID: mdl-23680506

ABSTRACT

INTRODUCTION: The quality of cause-of-death reporting on death certificates affects the usefulness of vital statistics for public health action. Heart disease deaths are overreported in the United States. We evaluated the impact of an intervention to reduce heart disease overreporting on other leading causes of death. METHODS: A multicomponent intervention comprising training and communication with hospital staff was implemented during July through December 2009 at 8 New York City hospitals reporting excessive heart disease deaths. We compared crude, age-adjusted, and race/ethnicity-adjusted proportions of leading, underlying causes of death reported during death certification by intervention and nonintervention hospitals during preintervention (January-June 2009) and postintervention (January-June 2010) periods. We also examined trends in leading causes of death for 2000 through 2010. RESULTS: At intervention hospitals, heart disease deaths declined by 54% postintervention; other leading causes of death (ie, malignant neoplasms, influenza and pneumonia, cerebrovascular disease, and chronic lower respiratory diseases) increased by 48% to 232%. Leading causes of death at nonintervention hospitals changed by 6% or less. In the preintervention period, differences in leading causes of death between intervention and nonintervention hospitals persisted after controlling for race/ethnicity and age; in the postintervention period, age accounted for most differences observed between intervention and nonintervention hospitals. Postintervention, malignant neoplasms became the leading cause of premature death (ie, deaths among patients aged 35-74 y) at intervention hospitals. CONCLUSION: A hospital-level intervention to reduce heart disease overreporting led to substantial changes to other leading causes of death, changing the leading cause of premature death. Heart disease overreporting is likely obscuring the true levels of cause-specific mortality.


Subject(s)
Cause of Death , Heart Diseases/mortality , Heart Diseases/prevention & control , Medical Staff, Hospital/education , Outcome and Process Assessment, Health Care/standards , Adult , Aged , Aged, 80 and over , Cause of Death/trends , Death Certificates , Female , Heart Diseases/classification , Heart Diseases/ethnology , Hospital Mortality/trends , Humans , International Classification of Diseases , Male , Medical Staff, Hospital/psychology , Middle Aged , Models, Statistical , New York City , Outcome and Process Assessment, Health Care/methods , Program Evaluation
13.
Am J Public Health ; 103(4): 733-9, 2013 Apr.
Article in English | MEDLINE | ID: mdl-22994186

ABSTRACT

OBJECTIVES: Heart disease death overreporting is problematic in New York City (NYC) and other US jurisdictions. We examined whether overreporting affects the premature (< 65 years) heart disease death rate disparity between non-Hispanic Blacks and non-Hispanic Whites in NYC. METHODS: We identified overreporting hospitals and used counts of premature heart disease deaths at reference hospitals to estimate corrected counts. We then corrected citywide, age-adjusted premature heart disease death rates among Blacks and Whites and a White-Black premature heart disease death disparity. RESULTS: At overreporting hospitals, 51% of the decedents were White compared with 25% at reference hospitals. Correcting the heart disease death counts at overreporting hospitals decreased the age-adjusted premature heart disease death rate 10.1% (from 41.5 to 37.3 per 100,000) among Whites compared with 4.2% (from 66.2 to 63.4 per 100,000) among Blacks. Correction increased the White-Black disparity 6.1% (from 24.6 to 26.1 per 100,000). CONCLUSIONS: In 2008, NYC's White-Black premature heart disease death disparity was underestimated because of overreporting by hospitals serving larger proportions of Whites. Efforts to reduce overreporting may increase the observed disparity, potentially obscuring any programmatic or policy-driven advances.


Subject(s)
Black or African American/statistics & numerical data , Cardiovascular Diseases/ethnology , Cardiovascular Diseases/mortality , Cause of Death , Hospital Mortality/trends , White People/statistics & numerical data , Adult , Clinical Coding , Confidence Intervals , Death Certificates , Female , Humans , International Classification of Diseases , Male , Middle Aged , New York City/epidemiology , Poisson Distribution
14.
Prev Chronic Dis ; 9: E157, 2012.
Article in English | MEDLINE | ID: mdl-23078668

ABSTRACT

INTRODUCTION: Poor-quality cause-of-death reporting reduces reliability of mortality statistics used to direct public health efforts. Overreporting of heart disease has been documented in New York City (NYC) and nationwide. Our objective was to evaluate the immediate and longer-term effects of a cause-of-death (COD) educational program that NYC's health department conducted at 8 hospitals on heart disease reporting and on average conditions per certificate, which are indicators of the quality of COD reporting. METHODS: From June 2009 through January 2010, we intervened at 8 hospitals that overreported heart disease deaths in 2008. We shared hospital-specific data on COD reporting, held conference calls with key hospital staff, and conducted in-service training. For deaths reported from January 2009 through June 2011, we compared the proportion of heart disease deaths and average number of conditions per death certificate before and after the intervention at both intervention and nonintervention hospitals. RESULTS: At intervention hospitals, the proportion of death certificates that reported heart disease as the cause of death decreased from 68.8% preintervention to 32.4% postintervention (P < .001). Individual hospital proportions ranged from 58.9% to 79.5% preintervention and 25.9% to 45.0% postintervention. At intervention hospitals the average number of conditions per death certificate increased from 2.4 conditions preintervention to 3.4 conditions postintervention (P < .001) and remained at 3.4 conditions a year later. At nonintervention hospitals, these measures remained relatively consistent across the intervention and postintervention period. CONCLUSION: This NYC health department's hospital-level intervention led to durable changes in COD reporting.


Subject(s)
Cause of Death , Death Certificates , Heart Diseases/mortality , Hospitals/statistics & numerical data , Quality Assurance, Health Care , Algorithms , Clinical Coding/standards , Heart Diseases/classification , Heart Diseases/epidemiology , Hospitals/trends , Humans , Inservice Training , International Classification of Diseases , Medical Staff, Hospital/education , New York City/epidemiology , Outcome and Process Assessment, Health Care/statistics & numerical data , Preventive Health Services , Qualitative Research , Regression Analysis
15.
J Healthc Qual ; 33(5): 28-36, 2011 Sep.
Article in English | MEDLINE | ID: mdl-23845131

ABSTRACT

Most older adults are admitted to home health care with some functional impairment related to chronic illness and/or hospitalization. This article describes: (1) the impact of a quality improvement initiative (QI) on functional outcomes of older, chronically ill patients served by a large homecare organization; and (2) key implementation challenges affecting intervention outcomes. Over 6,000 patients were included in two dissemination phases. Phase 1 randomly assigned service delivery teams to intervention (QI) or usual care (UC). Phase 2 spread the intervention to UC teams. Phase 1 yielded statistically significant, albeit modest, functional improvements among intervention team patients relative to UC. Phase 2 improvements in the original intervention group were smaller, suggesting some regression to the mean. UC teams did not "catch up" when exposed to the intervention in Phase 2. Analysis of the implementation process suggested that modification of improvement strategies and "dilution" of peer-to-peer communication hindered additional Phase 2 improvements. The findings highlight the challenges of relying on peer-to-peer spread, and of distinguishing the core elements of an effective improvement strategy that must be spread consistently from those that can be adapted to variations within and across organizations.


Subject(s)
Activities of Daily Living , Home Care Services , Quality Improvement/standards , Aged , Aged, 80 and over , Chronic Disease/therapy , Female , Home Care Services/standards , Humans , Interdisciplinary Communication , Male , Middle Aged , New York , Nurses, Community Health/standards , Patient Care Team
16.
Health Care Financ Rev ; 28(3): 77-94, 2007.
Article in English | MEDLINE | ID: mdl-17645157

ABSTRACT

Risk adjustment is a critical tool in public reporting of quality measures. Its aim is to level the playing field so that providers serving different patients can be meaningfully compared. We used a theory and evidence-based approach to develop risk-adjustment models for the 10 publicly reported home health quality measures and compared their performance with current models developed using a data-driven stepwise approach. Overall, the quality ratings for most agencies were similar regardless of approach. Theory and evidence-based models have the potential to simplify risk adjustment, and thereby improve provider and consumer understanding and confidence in public reporting.


Subject(s)
Home Care Agencies/standards , Medicare/standards , Outcome Assessment, Health Care/statistics & numerical data , Quality Indicators, Health Care/statistics & numerical data , Risk Adjustment/methods , Aged , Benchmarking , Certification , Health Services Research , Home Care Agencies/statistics & numerical data , Humans , Information Dissemination , Mandatory Reporting , United States
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