Analysis of the Massachusetts Health Care Reform Plan suggests national health care reform may require larger numbers of support personnel, rather than requiring greater numbers of physicians and nurses themselves.
Most Massachusetts physician groups are using results from a statewide patient survey to help improve patient experiences, but a significant number are not making use of the information or are making relatively limited efforts.
Performance-based payments are increasingly common in primary care. With persistent disparities in the quality of care that different populations receive, however, such payments may steer new resources away from the care of racial and ethnic minorities and people of low socioeconomic status. We simulated performance-based payments to Massachusetts practices serving higher and lower shares of patients from these vulnerable communities in Massachusetts. Typical practices serving higher shares of vulnerable populations would receive less per practice compared to others, by estimated amounts of more than $7,000.
The authors aggregated claims data for the years 2004 and 2005 from four health plans in Massachusetts.
Health plans and other payers should address statistical uncertainty when they use physician cost-profiles to categorize physicians into low or high-cost tiers.
Patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. But such characteristics are poor proxies for performance on clinical quality measures.
The authors studied how health information exchange systems are established by examining the decisions of key stakeholders participating in a health information exchange pilot project in 3 Massachusetts communities.
Research has shown that managed care (MC) slowed the rate of growth in health care spending in the 1990s, primarily via lower unit prices paid.
To describe practice patterns of primary care physicians (PCPs) for the diagnosis, treatment and management of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), the authors surveyed 556 PCPs in Boston, Chicago, and Los Angeles (RR=52%). Only 62% reported ever seeing a patient like the one described in the vignette. In all, 16% were 'not at all' familiar with CP/CPPS, and 48% were 'not at all' familiar with the National Institutes of Health classification scheme. PCPs reported practice patterns regarding CP/CPPS, which are not supported by evidence.
The authors found an association between P4P incentives and the use of quality improvement initiatives.
Hospital policies and practices related to breastfeeding may have long-term health effects. The Ten Steps to Successful Breastfeeding provide an evidence-based standard, which may be used to assess individual hospitals.
The Massachusetts plan to extend health insurance coverage to nearly all of the state's residents offers several lessons related to health reform.
Describes a quality assurance effort aimed at defining the characteristics of the patient population of the Connecticut Mental Health Center.
NEPs represent a valuable and underexploited opportunity to promote risk reduction efforts beyond the avoidance of needle sharing.
Because of time constraints in the office environment, problems of concern to elderly patients may not be raised during clinic visits.
Portfolio-driven reform : Vermont teachers' understanding of mathematical problem solving and related changes in classroom practice
Briefly describes the Vermont experience with portfolio assessment, and summarizes the findings of the RAND evaluation of the program.
This report is intended for practitioners, researchers, and policymakers concerned with current performance assessment efforts and their effects on instructional quality.
Interim report, the reliability of Vermont portfolio scores in the 1992-93 school year