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[PMID]:29215239
[Au] Autor:Fronstin P; Roebuck MC
[Ti] Título:Health Plan Switching: A Case Study--Implications for Private- and Public-Health-Insurance Exchanges and Increased Health Plan Choice.
[So] Source:EBRI Issue Brief;(432):1-20, 2017 03 23.
[Is] ISSN:0887-137X
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Comportamento de Escolha
Planos de Assistência de Saúde para Empregados/estatística & dados numéricos
Trocas de Seguro de Saúde
Seguro Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Sistemas Pré-Pagos de Saúde/estatística & dados numéricos
Seres Humanos
Seguradoras/estatística & dados numéricos
Masculino
Poupança para Cobertura de Despesas Médicas/estatística & dados numéricos
Meia-Idade
Organizações de Prestadores Preferenciais/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE


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[PMID]:29235785
[Au] Autor:Patel YM; Guterman S
[Ti] Título:The Evolution of Private Plans in Medicare.
[So] Source:Issue Brief (Commonw Fund);2017:1-10, 2017 Dec 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: Since the 1980s, private plans have played an increasingly important role in the Medicare program. While initially created with the goals of reducing costs, improving choice, and enhancing quality, risk-based plans--now known as Medicare Advantage plans--have undergone significant policy changes since their inception; these changes have not always aligned with the original policy objectives. Goal: To examine major policy changes to Medicare risk plans and the effects of these policies on plan participation, enrollment, average premiums and cost-sharing, total costs to Medicare, and quality of care. Methods: Review of key policy documents, reports, position statements, and academic studies. Findings and Conclusions: Private plans have changed considerably since their introduction into Medicare. Enrollment has risen to 33 percent of all Medicare beneficiaries; 99 percent of beneficiaries have access to private plans in 2017. Recent policies have improved risk-adjustment methods, rewarded plans' performance on quality of care, and reduced average payments to private plans to 100 percent of traditional Medicare spending. As enrollment in private plans continues to grow and as health care costs rise, policymakers should enhance incentives for private plans to meet intended goals for higher-quality care at lower cost.
[Mh] Termos MeSH primário: Medicare Part C/estatística & dados numéricos
Medicare/estatística & dados numéricos
Setor Privado/estatística & dados numéricos
[Mh] Termos MeSH secundário: Custo Compartilhado de Seguro
Planos de Pagamento por Serviço Prestado/economia
Planos de Pagamento por Serviço Prestado/tendências
Previsões
Sistemas Pré-Pagos de Saúde
Seres Humanos
Medicare/tendências
Medicare Part C/tendências
Qualidade da Assistência à Saúde
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28958127
[Au] Autor:Polski D; Weiner J; Zhang Y
[Ad] Endereço:Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
[Ti] Título:Narrow Networks on the Individual Marketplace in 2017.
[So] Source:LDI Issue Brief;21(8):1-6, 2017 09.
[Is] ISSN:1553-0671
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This Issue Brief describes the breadth of physician networks on the ACA marketplaces in 2017. We find that the overall rate of narrow networks is 21%, which is a decline since 2014 (31%) and 2016 (25%). Narrow networks are concentrated in plans sold on state-based marketplaces, at 42%, compared to 10% of plans on federally-facilitated marketplaces. Issuers that have traditionally offered Medicaid coverage have the highest prevalence of narrow network plans at 36%, with regional/local plans and provider-based plans close behind at 27% and 30%. We also find large differences in narrow networks by state and by plan type.
[Mh] Termos MeSH primário: Trocas de Seguro de Saúde/estatística & dados numéricos
Seguro Saúde/estatística & dados numéricos
Patient Protection and Affordable Care Act/estatística & dados numéricos
[Mh] Termos MeSH secundário: Sistemas Pré-Pagos de Saúde/estatística & dados numéricos
Acesso aos Serviços de Saúde
Seres Humanos
Medicaid
Médicos
Organizações de Prestadores Preferenciais/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171006
[Lr] Data última revisão:
171006
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:170930
[St] Status:MEDLINE


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[PMID]:28838950
[Au] Autor:Gilchrist-Scott DH; Feinstein JA; Agrawal R
[Ad] Endereço:Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
[Ti] Título:Medicaid Managed Care Structures and Care Coordination.
[So] Source:Pediatrics;140(3), 2017 Sep.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. METHODS: Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. RESULTS: In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, = .034) and receipt of care coordination (adjusted odds ratio: 1.37, = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, = .05) and receipt of care coordination (adjusted odds ratio: 0.71, < .001). Fee-for-service served as the referent. CONCLUSIONS: State utilization of MMC varied widely. These data suggest that care coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs.
[Mh] Termos MeSH primário: Administração de Caso/estatística & dados numéricos
Planos de Pagamento por Serviço Prestado/estatística & dados numéricos
Acesso aos Serviços de Saúde/estatística & dados numéricos
Programas de Assistência Gerenciada/estatística & dados numéricos
Medicaid/organização & administração
[Mh] Termos MeSH secundário: Adolescente
Criança
Estudos Transversais
Feminino
Pesquisas sobre Serviços de Saúde
Sistemas Pré-Pagos de Saúde/estatística & dados numéricos
Seres Humanos
Masculino
Atenção Primária à Saúde
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171111
[Lr] Data última revisão:
171111
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE


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[PMID]:28614127
[Au] Autor:Mahajan A; Islam SD; Schwartz MJ; Cannesson M
[Ad] Endereço:From the *Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, UCLA Health, Los Angeles, California; †Kaiser Permanente Medical Center, San Francisco, California; and ‡BDC Advisors, Miami, Flordia.
[Ti] Título:A Hospital Is Not Just a Factory, but a Complex Adaptive System-Implications for Perioperative Care.
[So] Source:Anesth Analg;125(1):333-341, 2017 Jul.
[Is] ISSN:1526-7598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Many methods used to improve hospital and perioperative services productivity and quality of care have assumed that the hospital is essentially a factory, and therefore, that industrial engineering and manufacturing-derived redesign approaches such as Six Sigma and Lean can be applied to hospitals and perioperative services just as they have been applied in factories. However, a hospital is not merely a factory but also a complex adaptive system (CAS). The hospital CAS has many subsystems, with perioperative care being an important one for which concepts of factory redesign are frequently advocated. In this article, we argue that applying only factory approaches such as lean methodologies or process standardization to complex systems such as perioperative care could account for difficulties and/or failures in improving performance in care delivery. Within perioperative services, only noncomplex/low-variance surgical episodes are amenable to manufacturing-based redesign. On the other hand, complex surgery/high-variance cases and preoperative segmentation (the process of distinguishing between normal and complex cases) can be viewed as CAS-like. These systems tend to self-organize, often resist or react unpredictably to attempts at control, and therefore require application of CAS principles to modify system behavior. We describe 2 examples of perioperative redesign to illustrate the concepts outlined above. These examples present complementary and contrasting cases from 2 leading delivery systems. The Mayo Clinic example illustrates the application of manufacturing-based redesign principles to a factory-like (high-volume, low-risk, and mature practice) clinical program, while the Kaiser Permanente example illustrates the application of both manufacturing-based and self-organization-based approaches to programs and processes that are not factory-like but CAS-like. In this article, we describe how factory-like processes and CAS can coexist within a hospital and how self-organization-based approaches can be used to improve care delivery in many situations where manufacturing-based approaches may not be appropriate.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde/organização & administração
Eficiência Organizacional
Hospitais
Modelos Organizacionais
Assistência Perioperatória
[Mh] Termos MeSH secundário: Prestação Integrada de Cuidados de Saúde/normas
Eficiência
Sistemas Pré-Pagos de Saúde/organização & administração
Necessidades e Demandas de Serviços de Saúde/organização & administração
Hospitais/normas
Seres Humanos
Determinação de Necessidades de Cuidados de Saúde/organização & administração
Assistência Perioperatória/normas
Melhoria de Qualidade/normas
Indicadores de Qualidade em Assistência à Saúde/normas
Fluxo de Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170814
[Lr] Data última revisão:
170814
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE
[do] DOI:10.1213/ANE.0000000000002144


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[PMID]:28613066
[Au] Autor:Lucia K; Hoadley J; Williams A
[Ad] Endereço:McCourt School of Public Policy, Health Policy Institute, Center on Health Insurance Reforms at Georgetown University.
[Ti] Título:Balance Billing by Health Care Providers: Assessing Consumer Protections Across States.
[So] Source:Issue Brief (Commonw Fund);16:1-10, 2017 Jun.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:ISSUE: Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing. However, when obtaining care at emergency departments and in-network hospitals, patients treated by an out-of-network provider may receive an unexpected "balance bill" for an amount beyond what the insurer paid. With no explicit federal protections against balance billing, some states have stepped in to protect consumers from this costly and confusing practice. GOAL: To better understand the scope of state laws to protect consumers from balance billing. METHODS: Analysis of laws in all 50 states and the District of Columbia and interviews with officials in eight states. FINDINGS AND CONCLUSIONS: Most states do not have laws that directly protect consumers from balance billing by an out-of-network provider for care delivered in an emergency department or in-network hospital. Of the 21 states offering protections, only six have a comprehensive approach to safeguarding consumers in both settings, and gaps remain even in these states. Because a federal policy solution might prove difficult, states may be better positioned in the short term to protect consumers.
[Mh] Termos MeSH primário: Contas a Pagar e a Receber
Defesa do Consumidor/economia
Defesa do Consumidor/legislação & jurisprudência
Dedutíveis e Cosseguros/economia
Dedutíveis e Cosseguros/legislação & jurisprudência
Honorários e Preços/legislação & jurisprudência
Seguro Saúde/economia
Seguro Saúde/legislação & jurisprudência
[Mh] Termos MeSH secundário: Serviços Médicos de Emergência/economia
Serviços Médicos de Emergência/legislação & jurisprudência
Sistemas Pré-Pagos de Saúde/economia
Sistemas Pré-Pagos de Saúde/legislação & jurisprudência
Seres Humanos
Organizações de Prestadores Preferenciais/economia
Organizações de Prestadores Preferenciais/legislação & jurisprudência
Governo Estadual
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170707
[Lr] Data última revisão:
170707
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:170615
[St] Status:MEDLINE


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[PMID]:28578605
[Au] Autor:Beveridge RA; Mendes SM; Caplan A; Rogstad TL; Olson V; Williams MC; McRae JM; Vargas S
[Ad] Endereço:1 Humana Inc, Louisville, KY, USA.
[Ti] Título:Mortality Differences Between Traditional Medicare and Medicare Advantage: A Risk-Adjusted Assessment Using Claims Data.
[So] Source:Inquiry;54:46958017709103, 2017 Jan 01.
[Is] ISSN:1945-7243
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Medicare Advantage (MA) has grown rapidly since the Affordable Care Act; nearly one-third of Medicare beneficiaries now choose MA. An assessment of the comparative value of the 2 options is confounded by an apparent selection bias favoring MA, as reflected in mortality differences. Previous assessments have been hampered by lack of access to claims diagnosis data for the MA population. An indirect comparison of mortality as an outcome variable was conducted by modeling mortality on a traditional fee-for-service (FFS) Medicare data set, applying the model to an MA data set, and then evaluating the ratio of actual-to-predicted mortality in the MA data set. The mortality model adjusted for clinical conditions and demographic factors. Model development considered the effect of potentially greater coding intensity in the MA population. Further analysis calculated ratios for subpopulations. Predicted, risk-adjusted mortality was lower in the MA population than in FFS Medicare. However, the ratio of actual-to-predicted mortality (0.80) suggested that the individuals in the MA data set were less likely to die than would be predicted had those individuals been enrolled in FFS Medicare. Differences between actual and predicted mortality were particularly pronounced in low income (dual eligibility), nonwhite race, high morbidity, and Health Maintenance Organization (HMO) subgroups. After controlling for baseline clinical risk as represented by claims diagnosis data, mortality differences favoring MA over FFS Medicare persisted, particularly in vulnerable subgroups and HMO plans. These findings suggest that differences in morbidity do not fully explain differences in mortality between the 2 programs.
[Mh] Termos MeSH primário: Revisão da Utilização de Seguros/estatística & dados numéricos
Medicare Part C/utilização
Medicare/utilização
Mortalidade/etnologia
Risco Ajustado
[Mh] Termos MeSH secundário: Planos de Pagamento por Serviço Prestado/utilização
Sistemas Pré-Pagos de Saúde/economia
Seres Humanos
Revisão da Utilização de Seguros/economia
Modelos Estatísticos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170724
[Lr] Data última revisão:
170724
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170606
[St] Status:MEDLINE
[do] DOI:10.1177/0046958017709103


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[PMID]:28400367
[Au] Autor:Reading SR; Go AS; Fang MC; Singer DE; Liu IA; Black MH; Udaltsova N; Reynolds K; Anticoagulation and Risk Factors in Atrial Fibrillation­Cardiovascular Research Network (ATRIA­CVRN) Investigators
[Ad] Endereço:Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
[Ti] Título:Health Literacy and Awareness of Atrial Fibrillation.
[So] Source:J Am Heart Assoc;6(4), 2017 Apr 11.
[Is] ISSN:2047-9980
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Atrial fibrillation (AF) is the most common clinically significant arrhythmia in adults and a major risk factor for ischemic stroke. Nonetheless, previous research suggests that many individuals diagnosed with AF lack awareness about their diagnosis and inadequate health literacy may be an important contributing factor to this finding. METHODS AND RESULTS: We examined the association between health literacy and awareness of an AF diagnosis in a large, ethnically diverse cohort of Kaiser Permanente Northern and Southern California adults diagnosed with AF between January 1, 2006 and June 30, 2009. Using self-reported questionnaire data completed between May 1, 2010 and September 30, 2010, awareness of an AF diagnosis was evaluated using the question "Have you ever been told by a doctor or other health professional that you have a heart rhythm problem called atrial fibrillation or atrial flutter?" and health literacy was assessed using a validated 3-item instrument examining problems because of reading, understanding, and filling out medical forms. Of the 12 517 patients diagnosed with AF, 14.5% were not aware of their AF diagnosis and 20.4% had inadequate health literacy. Patients with inadequate health literacy were less likely to be aware of their AF diagnosis compared with patients with adequate health literacy (prevalence ratio=0.96; 95% CI [0.94, 0.98]), adjusting for sociodemographics, health behaviors, and clinical characteristics. CONCLUSIONS: Lower health literacy is independently associated with less awareness of AF diagnosis. Strategies designed to increase patient awareness of AF and its complications are warranted among individuals with limited health literacy.
[Mh] Termos MeSH primário: Fibrilação Atrial/psicologia
Flutter Atrial/psicologia
Conscientização
Conhecimentos, Atitudes e Prática em Saúde
Alfabetização em Saúde
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Fibrilação Atrial/diagnóstico
Fibrilação Atrial/fisiopatologia
Fibrilação Atrial/terapia
Flutter Atrial/diagnóstico
Flutter Atrial/fisiopatologia
Flutter Atrial/terapia
California
Compreensão
Estudos Transversais
Feminino
Sistemas Pré-Pagos de Saúde
Nível de Saúde
Seres Humanos
Masculino
Meia-Idade
Educação de Pacientes como Assunto
Fatores Socioeconômicos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170413
[St] Status:MEDLINE


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[PMID]:28253525
[Au] Autor:Goshen R; Mizrahi B; Akiva P; Kinar Y; Choman E; Shalev V; Sopik V; Kariv R; Narod SA
[Ad] Endereço:Medial Early Sign, Kfar Malal, Israel.
[Ti] Título:Predicting the presence of colon cancer in members of a health maintenance organisation by evaluating analytes from standard laboratory records.
[So] Source:Br J Cancer;116(7):944-950, 2017 Mar 28.
[Is] ISSN:1532-1827
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A valid risk prediction model for colorectal cancer (CRC) could be used to identify individuals in the population who would most benefit from CRC screening. We evaluated the potential for information derived from a panel of blood tests to predict a diagnosis of CRC from 1 month to 3 years in the future. METHODS: We abstracted information on 1755 CRC cases and 54 730 matched cancer-free controls who had one or more blood tests recorded in the electronic records of Maccabi Health Services (MHS) during the period 30-180 days before diagnosis. A scoring model (CRC score) was constructed using the study subjects' blood test results. We calculated the odds ratio for being diagnosed with CRC after the date of blood draw, according to CRC score and time from blood draw. RESULTS: The odds ratio for having CRC detected within 6 months for those with a score of four or greater (vs three or less) was 7.3 (95% CI: 6.3-8.5) for men and was 7.8 (95% CI: 6.7-9.1) for women. CONCLUSIONS: Information taken from routine blood tests can be used to predict the risk of being diagnosed with CRC in the near future.
[Mh] Termos MeSH primário: Técnicas de Laboratório Clínico/normas
Neoplasias Colorretais/diagnóstico
Detecção Precoce de Câncer
Registros Eletrônicos de Saúde/normas
Sistemas Pré-Pagos de Saúde/recursos humanos
[Mh] Termos MeSH secundário: Adulto
Idoso
Estudos de Casos e Controles
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estadiamento de Neoplasias
Prognóstico
Medição de Risco
Fatores de Risco
[Pt] Tipo de publicação:COMPARATIVE STUDY; EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170525
[Lr] Data última revisão:
170525
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170303
[St] Status:MEDLINE
[do] DOI:10.1038/bjc.2017.53


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[PMID]:28189609
[Au] Autor:Adams-Piper ER; Guaderrama NM; Chen Q; Whitcomb EL
[Ad] Endereço:Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, University of California, Irvine, Orange, CA.
[Ti] Título:Impact of surgical training on the performance of proposed quality measures for hysterectomy for pelvic organ prolapse.
[So] Source:Am J Obstet Gynecol;216(6):588.e1-588.e5, 2017 Jun.
[Is] ISSN:1097-6868
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Recent healthcare reform has led to increased emphasis on standardized provision of quality care. Use of government- and organization-approved quality measures is 1 way to document quality care. Quality measures, to improve care and aid in reimbursement, are being proposed and vetted in many areas of medicine. OBJECTIVES: We aimed to assess performance of proposed quality measures that pertain to hysterectomy for pelvic organ prolapse stratified by surgical training. The 4 quality measures that we assessed were (1) the documentation of offering conservative treatment of pelvic organ prolapse, (2) the quantitative assessment of pelvic organ prolapse (Pelvic Organ Prolapse-Quantification or Baden-Walker), (3) the performance of an apical support procedure, and (4) the performance of cystoscopy at time of hysterectomy. STUDY DESIGN: Patients who underwent hysterectomy for pelvic organ prolapse from January 1 to December 31, 2008, within a large healthcare maintenance organization were identified by diagnostic and procedural codes within the electronic medical record. Medical records were reviewed extensively for demographic and clinical data that included the performance of the 4 proposed quality measures and the training background of the primary surgeon (gynecologic generalist, fellowship-trained surgeon in Female Pelvic Medicine and Reconstructive Surgery, and "grandfathered" Female Pelvic Medicine and Reconstructive Surgery). Data were analyzed with the use of descriptive statistics. Inferential statistics with chi-squared tests were used to compare performance rates of quality measures that were stratified by surgical training. Probability values <.05 were considered statistically significant. RESULTS: Six hundred thirty patients who underwent hysterectomy for pelvic organ prolapse in 2008 had complete records available for analysis. Fellowship-trained surgeons performed 302 hysterectomies for pelvic organ prolapse; grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed 98 hysterectomies, and gynecologic generalist surgeons performed 230 hysterectomies. Fellowship-trained surgeons had the highest performance rates for individual quality measures (91.4-98.7%) and cumulative performance of all measures (80.8% of cases). Grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed significantly fewer measures (80.6-95.9% performance rate for individual measures; 65.3% cumulatively for all measures) than fellowship-trained surgeons and more than gynecologic generalists (64.3-70% for individual measures; 29.1% cumulatively for all measures). There was an association between surgeon training background and number of hysterectomies performed for pelvic organ prolapse, with specialist surgeons performing more hysterectomies. When quality measure performance was stratified by surgeon volume, similar significant associations were found, with high-volume surgeons performing more quality measures than low-volume surgeons. CONCLUSION: Within a large healthcare maintenance organization, fellowship-trained Female Pelvic Medicine and Reconstructive Surgery surgeons were more likely to perform proposed quality measures in women who underwent hysterectomy for pelvic organ prolapse compared with those surgeons without such training. Grandfathered Female Pelvic Medicine and Reconstructive Surgery surgeons performed measures more frequently than gynecologic generalists but less than fellowship-trained surgeons. Further study is indicated to correlate the proposed quality measures with clinical outcomes.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos em Ginecologia/educação
Histerectomia/normas
[Mh] Termos MeSH secundário: Competência Clínica
Cistoscopia
Bolsas de Estudo
Feminino
Sistemas Pré-Pagos de Saúde
Seres Humanos
Histerectomia/métodos
Prolapso de Órgão Pélvico/cirurgia
Qualidade da Assistência à Saúde
Procedimentos Cirúrgicos Reconstrutivos/educação
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170804
[Lr] Data última revisão:
170804
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170213
[St] Status:MEDLINE



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