Health services research
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Although value-based purchasing (VBP) holds promise for encouraging quality improvement and addressing rising costs, currently there is limited evidence about how best to structure and implement VBP programs. In this commentary, we highlight several issues for improving evaluations of VBP programs. ⋯ Impact research can be improved by creating better outcome measures, increasing the availability of linked patient-level data, and advancing synthesis research. We offer several recommendations for improving the foundation to conduct evaluations of VBP programs to better inform policy and practice.
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Health services research · Oct 2010
Comparative StudyUse of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics.
To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. ⋯ Medicare-eligible VA primary care patients followed over 4 consecutive years used significant primary care and specialty care outside of VA. Community-based patients offset decreased VA use with increased service use paid by Medicare, suggesting that increasing access to VA primary care via community clinics may fragment veteran care in unintended ways. Coordination of care between VA and non-VA providers and health care systems is essential to improve the quality and continuity of care.
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Health services research · Oct 2010
Declining fertility and the use of cesarean delivery: evidence from a population-based study in Taiwan.
To test the hypothesis that declining fertility would affect the number of cesarean sections (c-sections) on maternal demand, but not medically indicated c-sections. ⋯ Our findings offer a precautionary note to countries experiencing a fertility decline. Policies to contain the rise of c-sections should understand the role of women's preferences, especially regarding cesarean deliveries on maternal request.