Medical care
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Comparative Study
Trends and geographic variation of opiate medication use in state Medicaid fee-for-service programs, 1996 to 2002.
Although studies have documented hospital and surgical service geographic variability, prescription use geographic variability is largely unknown. Opiate pain medications are widely used, particularly because the promulgation of clinical guidelines promoting aggressive pain treatment. This study describes temporal and interstate variability in aggregate prescription opiate medication use within U.S. Medicaid programs. ⋯ The dispensing of opiate medications in Medicaid programs increased at almost twice the rate of nonpain-related medications during the 7-year study period. Large, unexplained geographic variation in aggregate use exists. The impact of Medicaid cost-containment strategies on utilization and outcomes should be investigated.
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Comparative Study
Health services utilization for people with HIV infection: comparison of a population targeted for outreach with the U.S. population in care.
Many persons with HIV infection do not receive consistent ambulatory medical care and are excluded from studies of patients in medical care. However, these hard-to-reach groups are important to study because they may be in greatest need of services. ⋯ Compared with HCSUS, the Outreach sample had far greater proportions of traditionally vulnerable groups, and were less likely to be in care if they had low CD4 counts. Furthermore, heavy alcohol use was only associated with low ambulatory utilization in Outreach. Generalizing from in care populations may not be warranted, while addressing heavy alcohol use may be effective at improving utilization of care for hard-to-reach HIV-positive populations.
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Analysis of subgroups such as different ethnic, language, or education groups selected from among a parent population is common in health disparities research. One goal of such analyses is to examine measurement equivalence, which includes both qualitative review of the meaning of items as well as quantitative examination of different levels of factorial invariance and differential item functioning. ⋯ Invariance of factor loadings across studied groups is required for valid comparisons of scale score or latent variable means. Strong and strict invariance may be less important in the context of basic research in which group differences in specific factors are indicative of individual differences that are important for scientific exploration. However, for most applications in which the aim is to ensure fairness and equity, strict factorial invariance is required. Health disparities research often focuses on self-reported clinical outcomes such as quality of life that are not observed directly. Latent variable models such as factor analyses are central to establishing valid assessment of such outcomes.
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Classical test theory and item response theory methods can provide useful and potentially different insights into the performance of items in a survey designed to elicit parental perceptions of dental care delivered to children in publicly funded programs. ⋯ The beta CAHPS(R) dental survey performed well and the revised instrument is recommended for future studies. Classical test theory and item response theory can provide complementary information about survey items.
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Comparative Study
Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care.
The hospital readmission rate has been proposed as an important outcome indicator computable from routine statistics. However, most commonly used measures raise conceptual issues. ⋯ Adjusted rates of potentially avoidable readmissions are scientifically sound enough to warrant their inclusion in hospital quality surveillance.