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Articles 1 - 9 of 9
Full-Text Articles in Health Services Research
Pharmacy Use By Dual-Eligible Non-Elderly Veterans With Private Healthcare Insurance, Brian C. Lund, Mary E. Charlton, Alan N. West
Pharmacy Use By Dual-Eligible Non-Elderly Veterans With Private Healthcare Insurance, Brian C. Lund, Mary E. Charlton, Alan N. West
Dartmouth Scholarship
The Veterans Health Administration (VHA) is the largest nationally integrated healthcare system in the United States, operating 168 medical centers and more than 1000 community based outpatient clinics. However, many veterans seek care outside the VHA system, particularly when they are also covered by state or federal programs such as Medicare or Medicaid, or have access to private health insurance, often through employment. Concerted efforts have been made to facilitate communication and coordinate care between VHA and private sector healthcare, but concurrent use of these systems adds to an already fragmented U.S health care system.
Measurement Challenges In Shared Decision Making: Putting The ‘Patient’ In Patient‐Reported Measures, Paul J. Barr, Glyn Elwyn
Measurement Challenges In Shared Decision Making: Putting The ‘Patient’ In Patient‐Reported Measures, Paul J. Barr, Glyn Elwyn
Dartmouth Scholarship
Measuring clinicians' shared decision-making (SDM) performance is a key requirement given the intensity of policy interest in many developed countries - yet it remains one of the most difficult methodological challenges, which is a concern for many stakeholders. In this Viewpoint Article, we investigate the development of existing patient-reported measures (PRMs) of SDM identified in a recent review. We find that patients were involved in the development of only four of the 13 measures. This lack of patient involvement in PRM development is associated with two major threats to content validity, common to all 13 PRMs of SDM: (i) an …
Implementing Shared Decision-Making: Consider All The Consequences, Glyn Elwyn, Dominick L. Frosch, Sarah Kobrin
Implementing Shared Decision-Making: Consider All The Consequences, Glyn Elwyn, Dominick L. Frosch, Sarah Kobrin
Dartmouth Scholarship
The ethical argument that shared decision-making is “the right” thing to do, however laudable, is unlikely to change how healthcare is organized, just as evidence alone will be an insufficient factor: practice change is governed by factors such as cost, profit margin, quality, and efficiency. It is helpful, therefore, when evaluating new approaches such as shared decision-making to conceptualize potential consequences in a way that is broad, long-term, and as relevant as possible to multiple stakeholders. Yet, so far, evaluation metrics for shared decision-making have been mostly focused on short-term outcomes, such as cognitive or affective consequences in patients. The …
The Gas Cylinder, The Motorcycle And The Village Health Team Member: A Proof-Of-Concept Study For The Use Of The Microsystems Quality Improvement Approach To Strengthen The Routine Immunization System In Uganda, Dorothy A. Bazos, Lea R. Ayers Lafave, Gautham Suresh, Kevin C. Shannon, Fred Nuwaha, Mark E. Splaine
The Gas Cylinder, The Motorcycle And The Village Health Team Member: A Proof-Of-Concept Study For The Use Of The Microsystems Quality Improvement Approach To Strengthen The Routine Immunization System In Uganda, Dorothy A. Bazos, Lea R. Ayers Lafave, Gautham Suresh, Kevin C. Shannon, Fred Nuwaha, Mark E. Splaine
Dartmouth Scholarship
Although global efforts to support routine immunization (RI) system strengthening have resulted in higher immunization rates, the World Health Organization (WHO) estimates that the proportion of children receiving recommended DPT3 vaccines has stagnated at 80% for the past 3 years (WHO Fact sheet-Immunization coverage 2014, WHO, 2014). Meeting the WHO goal of 90% national DPT3 coverage may require locally based strategies to support conventional approaches. The Africa Routine Immunization Systems Essentials-System Innovation (ARISE-SI) initiative is a proof-of-concept study to assess the application of the Microsystems Quality Improvement Approach for generating local solutions to strengthen RI systems and reach those unreached …
Assessments Of The Extent To Which Health‐Care Providers Involve Patients In Decision Making: A Systematic Review Of Studies Using The Option Instrument, Nicolas Couët, Sophie Desroches, Hubert Robitaille, Hugues Vaillancourt, Annie Leblanc, Stéphane Turcotte, Glyn Elwyn, France Légaré
Assessments Of The Extent To Which Health‐Care Providers Involve Patients In Decision Making: A Systematic Review Of Studies Using The Option Instrument, Nicolas Couët, Sophie Desroches, Hubert Robitaille, Hugues Vaillancourt, Annie Leblanc, Stéphane Turcotte, Glyn Elwyn, France Légaré
Dartmouth Scholarship
Background: We have no clear overview of the extent to which health-care providers involve patients in the decision-making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this. Objective: To systematically review studies that used the OPTION instrument to observe the extent to which health-care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation. We conducted online literature searches in multiple databases (2001-12) and gathered further data through networking.
Assessing Medicare Beneficiaries’ Strength‐Of‐Preference Scores For Health Care Options: How Engaging Does The Elicitation Technique Need To Be?, Trafford Crump, Hilary A. Llewellyn-Thomas
Assessing Medicare Beneficiaries’ Strength‐Of‐Preference Scores For Health Care Options: How Engaging Does The Elicitation Technique Need To Be?, Trafford Crump, Hilary A. Llewellyn-Thomas
Dartmouth Scholarship
The objective was to determine if participants’ strength‐of‐preference scores for elective health care interventions at the end‐of‐life (EOL) elicited using a non‐engaging technique are affected by their prior use of an engaging elicitation technique.
Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner
Is American Health Care Uniquely Inefficient?, Alan M. Garber, Jonathan Skinner
Dartmouth Scholarship
No abstract provided.
Productivity Spillovers In Healthcare: Evidence From The Treatment Of Heart Attacks, Amitabh Chandra, Douglas O. Staiger
Productivity Spillovers In Healthcare: Evidence From The Treatment Of Heart Attacks, Amitabh Chandra, Douglas O. Staiger
Dartmouth Scholarship
A large literature in medicine documents variation across areas in the use of surgical treatments that is unrelated to outcomes. Observers of this phenomena have invoked “flat of the curve medicine” to explain these facts, and have advocated for reductions in spending in high-use areas. In contrast, we develop a simple Roy model of patient treatment choice with productivity spillovers that can generate the empirical facts. Our model predicts that high-use areas will have higher returns to surgery, better outcomes among patients most appropriate for surgery, and worse outcomes among patients least appropriate for surgery, while displaying no relationship between …
Could Distance Be A Proxy For Severity-Of-Illness? A Comparison Of Hospital Costs In Distant And Local Patients., H G. Welch, E B. Larson, W P. Welch
Could Distance Be A Proxy For Severity-Of-Illness? A Comparison Of Hospital Costs In Distant And Local Patients., H G. Welch, E B. Larson, W P. Welch
Dartmouth Scholarship
We test the hypothesis that hospital costs, after adjusting for DRG mix, are higher in distant patients than in local patients. Data were obtained from the Washington State Commission Hospital Abstract Reporting System (CHARS) and included all patients discharged from 15 metropolitan hospitals in the state of Washington during fiscal year 1987 (N = 181,072).