Biomedical subjects

Sarah C Shih

Publications and source records attributed to Sarah C Shih.

4 recordsLinked to original sources

PubMed2005

The relationship between quality and utilization in managed care.

OBJECTIVE: To examine correlations of commercial health plan performance on Health Plan Employer Data and Information Set (HEDIS) effectiveness-of-care measures with utilization rates, as a proxy for cost. STUDY DESIGN: Cross-sectional study of 254 commercial health plans. METHODS: This report used data reported by commercial managed care plans in the 2003 HEDIS dataset. Utilization measures included access to care (the proportion of adults with at least 1 primary care or preventive visit), outpatient use (the number of outpatient visits per 1000 members per year), inpatient discharges (the number of inpatient discharges for medical conditions per 1000 members per year), and inpatient days (inpatient hospital days for medical conditions per 1000 members per year). A composite quality score was calculated from HEDIS indicators. Estimates of health plan membership demographics were identified from Consumer Assessment of Health Plans (CAHPS) survey data. Of 316 reporting plans, 254 reported sufficient data to be included in this analysis. Bivariate correlations and multivariate regressions (controlling for health plan and membership characteristics) were conducted. RESULTS: Quality was positively correlated with access to outpatient care (r = 0.46, P < .001), negatively associated with inpatient days (r = -0.30, P < .001), and not associated with total outpatient visits (r = 0.04, not significant). Regression results controlling for selected plan and member characteristics demonstrated similar findings. CONCLUSIONS: Although the mechanism of this cross-sectional association is unclear, these data provide important starting points for further research on the interrelationships of quality and resource use.

Adult↗

PubMed2005

Practice systems for chronic care: frequency and dependence on an electronic medical record.

OBJECTIVES: To document the presence and functioning of different practice systems in a small sample of medical groups in Minnesota and to examine the relationship between the presence of practice systems and prior adoption of an electronic medical record (EMR). STUDY DESIGN: Descriptive study of the frequency of practice systems in 11 medical groups. METHODS: We recruited 11 medical groups for the study. Four groups had an EMR; the other groups used paper medical records, often supplemented by electronic ordering or data systems. Using an on-site audit team, we validated the presence of practice systems organized under 8 categories. RESULTS: All of the medical groups had implemented a substantial number of practice systems for care management of patients with chronic conditions. Although the medical groups with an EMR tended to have more comprehensive practice systems in place, the medical groups without an EMR also had most of the practice systems. CONCLUSIONS: Although required in some functions, an EMR may not be necessary in facilitating practice systems that support consistent management of patients with chronic illness. Approaches are needed that will encourage the implementation of practice systems in medical groups with and without an EMR.

Ambulatory Care Information Systems↗

PubMed2003

Standardized health plan reporting in four areas of preventive health care.

PURPOSE: This paper discusses first-year reporting by commercial managed care organizations (MCOs) of new measures in the 2000 Health Plan Employer Data and Information Set (HEDIS). The four measures include screening for chlamydia in young women, controlling blood pressure to <140/90mmHg in patients with hypertension, prescribing appropriate medications for persons with asthma (treatment adherence), and providing counseling to women about managing menopause (survey measure). METHODS: In 2000, some 384 commercial MCOs submitted HEDIS results to the National Committee for Quality Assurance (NCQA). Results of the four new HEDIS measures were linked with audit reports and other health plan data-reporting characteristics collected by NCQA. Performance variables were stratified by MCOs' willingness to report their results publicly, size of enrollment, performance on other (non-first year) HEDIS measures, and data collection issues. RESULTS: The mean average performance on the four measures was lowest in chlamydia screening in women (16% for ages 21 to 26 years) and highest for use of appropriate medications for people with asthma (59% for ages 18 to 56 years). The mean average of controlling high blood pressure was 39%. Scores on the management of menopause (MoM) measure ranged from 33.7 (for rating of information) to 72.6 (for exposure to counseling). CONCLUSIONS: The initial MCO baseline rates reported here suggest that much work is needed to improve the quality of care in these areas. Plan characteristics shown to be associated with higher performance on existing HEDIS measures do not predict performance on the new measures. In addition, fewer plans reported on the new measures than on established HEDIS measures. To ensure continued improvement in chlamydia screening in women, controlling high blood pressure, use of appropriate medications for people with asthma, and MoM, incentives for tracking and reporting on these health issues must be explored.

Adolescent↗

PubMed2002

Mental health care quality under managed care in the United States: a view from the Health Employer Data and Information Set (HEDIS).

OBJECTIVE: This study examined the rates and correlates of mental health care performance measures in the Health Employer Data and Information Set (HEDIS). METHOD: For all 384 health maintenance organizations (HMOs) participating in the HEDIS program of the National Committee for Quality Assurance during 1999, analyses examined the rates of compliance with five mental health care performance measures and their association with general medical care quality, public reporting, and HMO finances. RESULTS: The mean rate of mental health care performance was 48.0%, compared with 69.2% for non-mental-health care domains. In multivariate models adjusted for plan characteristics, scores for worse quality of non-mental-health domains, failure to report data publicly, and low medical-loss ratio (proportion of revenues spent on clinical care) all predicted poor mental health care performance. CONCLUSIONS: Better general medical care, transparency of reporting, and commitment of fiscal resources to clinical care predicted better mental health care performance for U.S. HMOs.

Health Maintenance Organizations↗