Health services research
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Health services research · Feb 2013
Hospital and surgeon variation in complications and repeat surgery following incident lumbar fusion for common degenerative diagnoses.
To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery. ⋯ To improve the safety of lumbar spinal fusion surgery, quality improvement efforts that focus on surgeons' discretionary use of operative techniques may be more effective than those that target hospitals.
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Health services research · Feb 2013
The importance of a high-performance work environment in hospitals.
To examine the benefits of a high-performance work environment (HPWE) for employees, patients, and hospitals. ⋯ Our findings underscore the potential benefits for providers, patients, and health care organizations of designing work environments that value and support a broad range of employees as having essential contributions to make to the care process and their organizations.
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Health services research · Dec 2012
The impact of the Affordable Care Act on Medicare Advantage plan availability and enrollment.
To assess the impact of the Patient Protection and Affordable Care Act's (ACA) changes in Medicare Advantage (MA) payment rates on the availability of and enrollment in MA plans. ⋯ The ACA-induced MA payment changes reduced the number of plan choices available for Medicare beneficiaries, but they have yet affected enrollment patterns.
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Health services research · Dec 2012
Choosing models for health care cost analyses: issues of nonlinearity and endogeneity.
To compare methods of analyzing endogenous treatment effect models for nonlinear outcomes and illustrate the impact of model specification on estimates of treatment effects such as health care costs. ⋯ When modeling cost or other nonlinear data with endogeneity, one should be aware of the impact of model specification and treatment effect choice on results.
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Health services research · Dec 2012
A two-compartment mixed-effects gamma regression model for quantifying between-unit variability in length of stay among children admitted to intensive care.
To quantify between-unit variability in mean length of stay (LoS) between intensive care units (ICUs) after adjusting for differences in case mix using a method that does not require arbitrary trimming of data. ⋯ The two-compartment model characterizes ICU LoS for short- and long-stay patients more effectively than a single-compartment model. There is significant site-level variation in the LoS among children admitted to ICUs in Australia and New Zealand. Differences in the site-level variation between short- and long-stay patients indicate differences in discharge practice.