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Biomedical subjects

Helen Burstin

Publications and source records attributed to Helen Burstin.

At least 19 recordsLinked to original sources
PubMed2007

A comparison of outcomes resulting from generalist vs specialist care for a single discrete medical condition: a systematic review and methodologic critique.

BACKGROUND: Studies of clinical outcomes for generalist vs specialist care for diagnoses within a specialist's narrow domain have tended to favor specialty care. METHODS: A MEDLINE search from January 1, 1980, through April 1, 2005, and a hand search of retrieved bibliographies of English-language studies that compared generalist vs specialist care for individual patients with a single discrete medical condition were performed. Two reviewers determined eligibility for each study and abstracted data onto a standardized instrument. RESULTS: A total of 49 articles met our inclusion criteria: 24 studies favored specialty care, 13 found no difference in outcomes, 7 varied by individual outcome, 1 depended on physician experience, and 4 favored generalist care. Only 8 studies reported integration into health delivery systems, 4 considered physician experience, 3 documented information technology support, and 2 considered the impact of care management programs. Selection bias was adequately addressed in 58% of studies that favored specialty care and in 71% of studies that found no difference or favored generalist care (P = .52). Studies that favored specialty care were less likely to consider 4 key, potentially confounding physician or practice characteristics compared with studies that found no difference or favored generalist care (3% vs 15% of potential instances, respectively; P = .009). CONCLUSIONS: The literature regarding the influence of generalist vs specialist care on outcomes for patients with a single discrete condition suffers from important methodologic shortcomings. Further research is needed to inform health care policy as it pertains to the optimal role of generalists and specialists in the physician marketplace.

Clinical Competence↗
PubMed2006

Preventable hospitalization and medicaid managed care: does race matter?

This study examines the preventable hospitalization patterns of Medicaid patients by race/ethnicity to determine whether Medicaid managed care (MMC) has been more effective in some subgroups than others. It uses logistic models for three states, comparing preventable hospitalizations with marker admissions (urgent admissions, insensitive to primary care). Hospital discharge data from the Healthcare Cost and Utilization Project State Inpatient database of the Agency for Health Care Research and Quality for New York, Pennsylvania, and Wisconsin residents aged 20-64 years is used. In a more urban state, New York, MMC was effective for Whites but not for minorities. In a more rural state, Wisconsin, MMC was effective for minorities. Overall, the evidence is not strong that any particular racial group consistently benefited from MMC, or that any state consistently showed a favorable impact of MMC across racial groups. However, racial/ethnic disparity associated with the risk of preventable hospitalization is significantly lower among Medicaid patients than among private fee-for-service patients.

Adult↗
PubMed2005

The national healthcare quality and disparities reports: an overview.

BACKGROUND: Congress directed the Agency for Healthcare Research and Quality (AHRQ) to lead an effort for the US Department of Health and Human Services (DHHS) to develop 2 annual reports: a National Healthcare Quality Report (NHQR) and a National Healthcare Disparities Report (NHDR). OBJECTIVES: This article lays out key concepts, definitions, statistical methods, and findings from these first ever national reports on quality and disparities. We also summarize some possible future directions for the reports. RESEARCH DESIGN: The NHQR and NHDR rely on secondary analysis of available data from over 40 established, national databases. The NHQR presents data at the national level, by sociodemographic characteristics, and at the state level. The NHDR presents data broken out by race/ethnicity and by socioeconomic status. MEASURES: The 2003 NHQR presented data on approximately 140 quality measures and the NHDR presented data on these same measures plus approximately 100 measures of access to care. RESULTS: The reports found that high healthcare quality is not a given and that disparities are pervasive throughout the US healthcare system. In addition, they found the quality and disparities issues are particularly apparent in preventive care, but that greater improvement is possible. CONCLUSIONS: As these reports evolve for the 2004 version and beyond, they will be a vital step in the effort to improve healthcare quality for all populations in the United States.

Adult↗
PubMed2004

A call for outcomes research in medical education.

The primary goal of medical education is to produce physicians who deliver high-quality health care. Recent calls for greater accountability in medical education and the development of outcomes research methodologies should encourage a new research effort to examine the effects of medical training upon clinical outcomes. The authors offer a research agenda that links medical education and quality of health care and give specific examples of potential research projects that would begin to examine that relationship. A proposed model of patient outcomes research in medical education recognizes the contributory effects of health care system-level factors as well as the continuum of medical education, process measures, and individual training and preparedness to deliver high-quality care. There exists an opportunity to create a research agenda in medical education outcomes research that is multidisciplinary, broad based, and focused on patient-centered outcomes.

Education, Medical↗
PubMed2004

Hispanic healthcare disparities: challenging the myth of a monolithic Hispanic population.

BACKGROUND: Hispanic Americans are often treated as a monolithic ethnic group with a single pattern of healthcare utilization. However, there could be considerable differences within this population. We examine the association between use of healthcare services and Hispanic Americans'country of ancestry or origin, language of interview, and length of time lived in the United States. METHODS: Our data come from the Medical Expenditure Panel Survey, a nationally representative survey of healthcare use and expenditures. Descriptive statistics and logistic regression results are presented. RESULTS: Multivariate models show that Mexicans and Cubans are less likely, and Puerto Ricans more likely, to have any emergency department visits than non-Hispanic whites. Mexicans, Central American/Caribbeans, and South Americans are less likely to have any prescription medications. All Hispanics are less likely to have any ambulatory visits and prescription medications, whereas only those with a Spanish-language interview are less likely to have emergency department visits and inpatient admissions. More recent immigrants are less likely to have any ambulatory care or emergency department visits, whereas all Hispanics born outside the United States are less likely to have any prescription medications. CONCLUSIONS: The Hispanic population is composed of many different groups with diverse health needs and different barriers to accessing care. Misconceptions of Hispanics as a monolithic population lacking within-group diversity could function as a barrier to efforts aimed at providing appropriate care to Hispanic persons and could be 1 factor contributing to inequalities in the availability, use, and quality of healthcare services in this population.

Adolescent↗
PubMed2004

Managed care and preventable hospitalization among Medicaid adults.

OBJECTIVE: The study examines the association between managed care enrollment and preventable hospitalization patterns of adult Medicaid enrollees hospitalized in four states. DATA SOURCES/STUDY SETTING: Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP) database of the Agency for Healthcare Research and Quality (AHRQ) for New York (NY), Pennsylvania (PA), Wisconsin (WI), and Tennessee (TN) residents in the age group 20-64 hospitalized in those states, linked to the Area Resource File (ARF) and American Hospital Association (AHA) survey files for 1997. STUDY DESIGN: The study uses separate logistic models for each state comparing preventable admissions with marker admissions (urgent, insensitive to primary care). The model controls for socioeconomic and demographic variables, and severity of illness. PRINCIPAL FINDINGS: Consistently in different states, private health maintenance organization (HMO) enrollment was associated with fewer preventable admissions than marker admissions, compared to private fee-for-service (FFS). However, Medicaid managed care enrollment was not associated with a reduction in preventable admissions, compared to Medicaid FFS. CONCLUSIONS: Our analysis suggests that the preventable hospitalization pattern for private HMO enrollees differs significantly from that for commercial FFS enrollees. However, little difference is found between Medicaid HMO enrollees and Medicaid FFS patients. The findings did not vary by the level of Medicaid managed care penetration in the study states.

Adult↗
PubMed2004

Assessing the nation's progress toward elimination of disparities in health care.

The Agency for Healthcare Research and Quality submitted the first annual National Healthcare Disparities Report to Congress in December, 2003. This first report will provide a snapshot of the state of racial, ethnic, and socioeconomic disparities in access and quality of care in America. It examines disparities in the general population and within the Agency's priority populations. While focused on extant data, the first report will form the foundation for future versions, which examines causes of disparities and shape solutions to the problem. As patient advocates and agents of change, primary care physicians play a critical role in efforts to eliminate disparities in health care. Continuing participation by primary care physicians in the development and refinement of the National Healthcare Disparities Report is essential.

Ethnicity↗
PubMed2003

Doctor performance and public accountability.

Public concern about the quality of health care has motivated governments, health-care funders, and clinicians to expand efforts to improve professional performance. In this paper, we illustrate such efforts from the perspective of three countries, the UK, the USA, and the Netherlands. The earliest strategies, which included continuing professional education, clinical audits, and peer review, were aimed at the individual doctor, and produced only modest effects. Other efforts, such as national implementation of practice guidelines, effective use of information technologies, and intensive involvement by doctors in continuous quality-improvement activities, are aimed more broadly at health-care systems. Much is yet unknown about whether these or other strategies--such as centralised supervision or regulation of quality improvement, or use of financial incentives--are effective. As demands for greater public accountability rise, continuing performance improvement efforts of each of our countries offer us opportunities to learn from one another.

Clinical Competence↗
PubMed2002

Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions: a new approach.

OBJECTIVE: To examine the association of primary care availability, HMO enrollment, and other person and location variables with potentially preventable hospitalization for adults in New York State, compared with other types of hospitalization. DATA SOURCES/STUDY SETTING: Hospital discharges of New York residents in the age group 20-64 hospitalized either in New York or in three contiguous states: New Jersey, Pennsylvania, or Connecticut using 1995 statewide discharge files from the Health care Cost and Utilization Project (HCUP) maintained by the Agency for Health care Research and Quality. STUDY DESIGN: A multinomial logit model uses the individual discharge as the unit of analysis. ACS admissions are compared with marker admissions (urgent but non-ACS) and referral sensitive surgeries (more discretionary), controlling for severity of illness. PRINCIPAL FINDINGS: Higher primary care density was associated with a lower likelihood of ACS admission, compared with marker admissions, without increasing referral-sensitive admissions. The study also supports the hypothesis of ACS admissions being less likely for private HMO enrollees than for other insured adults. This result was not found for Medicaid HMO enrollees, even by comparison to other Medicaid enrollees. CONCLUSIONS: A key policy-relevant result is the negative association of primary care physicians per capita with the likelihood of ACS admissions, without an offsetting association with resource costs via referral-sensitive admissions. The method allowed for examining the possible effects of personal and area variables on one type of hospital admission (ACS) by contrast with other specific types of admissions. This type of analysis could be strengthened in several ways for a defined population when better data on individual patients and several time periods are used.

Adult↗
PubMed2002

On the front lines: family physicians' preparedness for bioterrorism.

OBJECTIVE: The events of September 11, 2001, and the nation's recent experience with anthrax assaults made bioterrorism preparedness a national priority. Because primary care physicians are among the sentinel responders to bioterrorist attacks, we sought to determine family physicians' beliefs about their preparedness for such an attack. STUDY DESIGN: In October 2001 we conducted a national survey of 976 family physicians randomly selected from the American Academy of Family Physicians' active membership directory. POPULATION: 614 (63%) family physicians responded to the survey. OUTCOMES MEASURED: Physicians' self-reported ability to "know what to do as a doctor in the event of a suspected bioterrorist attack, recognize signs and symptoms of an illness due to bioterrorism, and know where to call to report a suspected bioterrorist attack." RESULTS: Ninety-five percent of physicians agreed that a bioterrorist attack is a real threat within the United States. However, only 27% of family physicians believed that the US health care system could respond effectively to a bioterrorist attack; fewer (17%) thought that their local medical communities could respond effectively. Twenty-six percent of physicians reported that they would know what to do as a doctor in the event of a bioterrorist attack. Only 18% had previous training in bioterrorism preparedness. In a multivariate analysis, physicians reported that preparedness for a bioterrorist attack was significantly associated with previous bioterrorism preparedness training (OR 3.9 [95% CI 2.4-6.3]) and knowing how to obtain information in the event of a bioterrorist attack (OR 6.4 [95% CI 3.9-10.6]). CONCLUSIONS: Only one quarter of family physicians felt prepared to respond to a bioterrorist event. However, training in bioterrorism preparedness was significantly associated with physicians' perceived ability to respond effectively to an attack. Primary care physicians need more training in bioterrorism preparedness and easy access to public health and medical information in the event of a bioterrorist attack.

Adult↗