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1.
Am J Manag Care ; 16(10): 753-9, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20964471

RESUMO

OBJECTIVE: To assess whether health plan members who used retail clinics chose that setting for minor conditions and continued to see other providers for more complex conditions. STUDY DESIGN: Retrospective analysis of claims data in a commercially insured population. METHODS: Health plan enrollment data were used to identify and describe the analysis population. Episode Treatment Groups were used to identify members with chronic conditions and to analyze reasons for retail clinic use, complexity of retail clinic visits, and care for chronic conditions in non-retail clinic settings. Logistic regression was used to study predictors of retail clinic use. RESULTS: Retail clinic users differed significantly from nonusers. The most significant predictors of retail clinic use were age, sex, and proximity to a retail clinic. Episodes of care treated in the retail clinic appeared to be less complex than similar episodes treated in other settings. Chronically ill members who used the retail clinic saw another provider for their chronic condition at rates similar to or higher than those of members who did not use the retail clinic. CONCLUSIONS: Individuals may be able to identify when conditions are minor enough to be treated in a retail clinic and serious enough to be treated by a traditional provider.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Organizações de Prestadores Preferenciais/estatística & dados numéricos , Adulto , Comportamento de Escolha , Doença Crônica , Tomada de Decisões , Atenção à Saúde/organização & administração , Humanos , Modelos Logísticos , Minnesota , Organizações de Prestadores Preferenciais/organização & administração , Estudos Retrospectivos , Estados Unidos
2.
Popul Health Manag ; 12(6): 325-31, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20038258

RESUMO

Health plans and other health care institutions may use indirect methods such as geocoding and surname analysis to estimate race, ethnicity, and socioeconomic status in an effort to measure disparities in care or target specific demographics. This study investigated whether stratifying by age improved imputations of race and ethnicity made through geocoding. Self-reported race and ethnicity from Medicaid enrollment records and from a health risk assessment administered by a large employer were used to validate imputation results from both an age-stratified model and a standard model. Sensitivity, specificity, and positive predictive value were calculated. Both approaches successfully imputed race and ethnicity for whites, blacks, Asians, and Hispanics. The age-stratified approach identified more blacks than did the unstratified approach, and correctly identified more blacks and whites. The two approaches worked equally well for identifying Asians and Hispanics. Age stratification may improve the accuracy of imputation methods, and help health care organizations to better understand the demographics of the people they serve.


Assuntos
Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Grupos Raciais , Adolescente , Adulto , Fatores Etários , Idoso , Planos de Seguro Blue Cross Blue Shield , Criança , Pré-Escolar , Geografia , Humanos , Lactente , Recém-Nascido , Medicaid , Pessoa de Meia-Idade , Minnesota , Estados Unidos , Adulto Jovem
3.
Popul Health Manag ; 12(2): 61-7, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19320605

RESUMO

A cross-sectional, retrospective medical and pharmaceutical claims data analysis was conducted to determine if Healthcare Effectiveness Data and Information Set (HEDIS) measures related to care for chronic conditions differed between enrollees in a traditional comprehensive major medical plan (CMM) and a consumer-directed health plan (CDHP). Eleven HEDIS measures for 2006 were compared for CMM and CDHP enrollees in a health plan. Measures included care for persons with diabetes, asthma, depression, cardiovascular disease, and low back pain, and for persons taking persistent medications for specific conditions. In the CMM population, 1,238,949 members were eligible to be included; 131,763 members in the CDHP population were eligible. Statistical significance testing was performed. As measured by HEDIS, CDHP enrollees received higher quality of care than did CMM enrollees in areas related to low back pain, and eye exams and nephropathy screening for persons with diabetes. No significant differences were found between CDHP enrollees and CMM enrollees for measures describing medication management for persons with depression and asthma, annual monitoring for persons taking persistent medications, cholesterol management for persons with cardiovascular disease, or HbA1c testing and low-density lipoprotein screening for persons with diabetes. Enrollees in CDHPs who have chronic conditions received care at levels of quality equal to or better than CMM enrollees. The potential for increased financial responsibility in the CDHP plan did not appear to deter those enrollees from pursuing necessary care. Future research should control for the demographic factors thought to influence both selection into a plan design and quality of care.


Assuntos
Doença Crônica/tratamento farmacológico , Participação da Comunidade , Planos de Assistência de Saúde para Empregados , Programas de Assistência Gerenciada , Qualidade da Assistência à Saúde , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
4.
J Am Dent Assoc ; 139(9): 1173-80, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18762627

RESUMO

BACKGROUND: The authors examined and compared dental services used by women before, during and after pregnancy. METHODS: In their study, the authors combined medical and dental claims data for 3,462 pregnant women in Minnesota with commercial dental insurance who had been pregnant between Jan. 1, 2004, and Dec. 31, 2005. The authors used McNemar pairwise comparisons, with each subject serving as her own control and her use of various dental services before pregnancy as her own baseline, to evaluate and compare the dental services used during and after pregnancy. RESULTS: During pregnancy, subjects' use of several dental services-radiographs, restorative services, third-molar extractions and anesthesia-decreased significantly (P < .001) in comparison with their prepregnancy use. After pregnancy, subjects' use of checkups, radiographs and restorative services showed significant increases (P < .001). CONCLUSIONS: The significant decreases in use of these services during pregnancy and significant increases after pregnancy may suggest that these women and their dentists were using these services only conservatively during pregnancy or postponing their use altogether until after delivery. CLINICAL IMPLICATIONS: This study's findings may provide useful background information to medical and dental providers, health care plan administrators and policymakers as they consider recommendations regarding oral health care for women during pregnancy.


Assuntos
Assistência Odontológica Integral/estatística & dados numéricos , Gravidez , Adolescente , Adulto , Anestesia Dentária/estatística & dados numéricos , Profilaxia Dentária/estatística & dados numéricos , Restauração Dentária Permanente/estatística & dados numéricos , Feminino , Humanos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Pessoa de Meia-Idade , Minnesota , Dente Serotino/cirurgia , Radiografia Dentária/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Saúde da Mulher
5.
Benefits Q ; 24(1): 46-54, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18543833

RESUMO

Although consumer-driven health plans (CDHPs) have grown dramatically, the question of whether CDHPs have reduced health care costs has not been answered definitively. This article presents what the authors believe to be the first study to analyze a large sample of claims data and to look in detail at different types of utilization among enrollees in a CDHP and those in a traditional comprehensive major medical (CMM) plan. After adjusting for the finding that CDHP enrollees are both younger and healthier than those in CMM plans, the authors found that CDHP enrollees show no consistent or significant utilization differences for measures over which consumers have little control (e.g., inpatient stays); lower utilization for measures over which consumers have greater control (e.g., emergency room visits); and higher utilization of preventive services.


Assuntos
Participação da Comunidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Poupança para Cobertura de Despesas Médicas/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Serviços de Diagnóstico/estatística & dados numéricos , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Lactente , Reembolso de Seguro de Saúde , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/economia , Revisão da Utilização de Recursos de Saúde
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