The Journal of ambulatory care management
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J Ambul Care Manage · Oct 2012
Evaluating outcomes of care and targeting quality improvement using Medicare health outcomes survey data.
The Medicare Health Outcomes Survey (HOS) provides a rich source of outcomes data on the Medicare Advantage (MA) program for the US Department of Health and Human Services, managed care organizations participating in Medicare, quality improvement organizations, and health services researchers working to improve quality of care for Medicare enrollees. Since 1998, the Centers for Medicare and Medicaid Services has collected longitudinal functional status information to assess the performance of Medicare managed care organizations. This introduction reviews the goals of the HOS program, how the HOS supports health care reform, and outlines recent HOS studies exploring data applications for monitoring outcomes and implementing quality improvement activities.
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J Ambul Care Manage · Jul 2012
Medical home and emergency department utilization among children with special health care needs: an analysis of the 2005-2006 National Survey of Children with Special Health Care Needs.
The purpose of this article was to determine whether medical home associated with reduction in emergency department utilization by children with special health care needs. The study comprised 40 723 children participating in the National Survey of Children with Special Health Care Needs. ⋯ Presence of medical home for severely limited children was associated with fewer ED visits (odds ratio, 0.59; 95% confidence interval, 0.50-0.70). Additional studies are warranted to explore specific components of a medical home and ED use.
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J Ambul Care Manage · Jul 2012
The commissioning reforms in the English National Health Service and their potential impact on primary care.
Reform of the National Health Service in England will increase power and responsibility for family doctors. They will have a larger role in planning and buying health care including control of substantial budgets. ⋯ This article considers the effect of the new clinical role in commissioning health care, changes to the accountability structures, and the effect on competition and integration within health services. It also considers the effect of new financial incentives and the possibility of creating conflicts of interest.
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J Ambul Care Manage · Jul 2012
The quality and outcomes framework in the United kingdom: indicators in transition.
The United Kingdom's pay-for-performance system, the Quality and Outcomes Framework, continues to evolve. Since its inception in 2004, the Quality and Outcomes Framework has provided a strong focus on evidence-based performance targets that remains a dominant theme. ⋯ In 2011, a new policy direction became apparent. New indicators accounting for almost 10% of the Quality and Outcomes Framework will be determined by achievement of targets reflecting the efficient use of health service resources.
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J Ambul Care Manage · Apr 2012
Characteristics of all, occasional, and frequent emergency department visits due to ambulatory care-sensitive conditions in Florida.
We studied characteristics of all, occasional, and frequent emergency department (ED) visits due to ambulatory care-sensitive conditions (ACSCs). We used a cross-sectional, split-sample design with multivariate logistic regressions using encounter-level, all-payer ED data from all Florida hospitals for the year of 2005. ⋯ We concluded that factors associated with ED use for ACSCs were similar for occasional and frequent ED users. Therefore, universal strategies for reduction of ED overutilization by increasing access to, timeliness, and quality of primary care for all patients likely to experience ACSCs should be used.