Scholars@Duke
Matthew Leonard Maciejewski

Matthew Leonard Maciejewski

Professor in Population Health Sciences
Population Health Sciences
mlm34@duke.edu
Duke Box 2720, Durham, NC 27705
215 Morris Street (Imperial), Suite 210, Durham, NC 27701

Selected Publications

Psychological Resilience and Physical Function in Veterans With Chronic Kidney Disease: A Brief Report.

Journal Article J Am Geriatr Soc · March 13, 2025 BACKGROUND: Psychological resilience has been characterized as the ability to recover from stressful life events. Not well studied is whether self-reported measures of psychological resilience are associated with physical function recovery. Therefore, we e ... Full text Link to item Cite

Assessing causality in deprescribing studies: A focus on adverse drug events and adverse drug withdrawal events.

Journal Article J Am Geriatr Soc · March 2025 Generating real-world evidence about the effect of medication discontinuation or dose reduction on outcomes, such as reduction of adverse drug effects (ADE; intended benefit) and occurrence of adverse drug withdrawal events (ADWE; unintended harm), is cruc ... Full text Link to item Cite

Health Expenditures of Patients With Diabetes After Bariatric Surgery: Comparing Gastric Bypass and Sleeve Gastrectomy.

Journal Article Ann Intern Med · March 2025 BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) differ in their effects on body weight and risk for reoperation. However, it is unclear whether long-term health expenditures differ by procedure type in patients with diabetes. OBJECT ... Full text Link to item Cite

Effectiveness of the 2023-to-2024 XBB.1.5 COVID-19 Vaccines Over Long-Term Follow-up : A Target Trial Emulation.

Journal Article Ann Intern Med · February 4, 2025 BACKGROUND: Monovalent COVID-19 vaccines targeting the XBB.1.5 Omicron variant were introduced in September 2023. In the absence of randomized controlled trials demonstrating their efficacy, information on real-world vaccine effectiveness (VE) is needed. O ... Full text Link to item Cite

Defining key deprescribing measures from electronic health data: A multisite data harmonization project.

Conference J Am Geriatr Soc · February 2025 BACKGROUND: Stopping or reducing risky or unneeded medications ("deprescribing") could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key ... Full text Link to item Cite

Outcomes of Community-Acquired Acute Kidney Injury: A Cohort Study of US Veterans.

Journal Article Med Care · February 1, 2025 BACKGROUND: Community-acquired acute kidney injury (CA-AKI) occurs outside of the hospital and is the most common form of AKI. CA-AKI is not well understood, which hinders efforts to prevent, identify, and manage CA-AKI. OBJECTIVE: Examine 30-day outcomes ... Full text Link to item Cite

Medicare Enrollment and Spending Among Patients Initiating Dialysis After the Affordable Care Act.

Journal Article JAMA Health Forum · December 6, 2024 IMPORTANCE: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. Medicare enrollment may have slowed for patients with incident ESKD who gained access to new private insurance options with the 2014 pas ... Full text Link to item Cite

Health Expenditures After Bariatric Surgery: A Retrospective Cohort Study.

Journal Article Ann Surg · December 1, 2024 OBJECTIVE: To compare expenditures between surgical and matched nonsurgical patients in a retrospective cohort study. BACKGROUND: Bariatric surgery leads to substantial improvements in weight and weight-related conditions, but prior literature on postsurgi ... Full text Link to item Cite

Enteral and Parenteral Nutrition Timing in eICU Collaborative Research Database by Race: A Retrospective Observational Study.

Journal Article J Surg Res · December 2024 INTRODUCTION: Racial and ethnic disparities in malnutrition are well-known, but it is unknown if there are disparities in early nutrition delivery for intensive care unit (ICU) patients, which is associated with better outcomes. We investigated the timing ... Full text Link to item Cite

Change in frailty among older COVID-19 survivors.

Journal Article J Am Geriatr Soc · December 2024 INTRODUCTION: COVID-19 survivors are at greater risk for new medical conditions. Among older adults, where multimorbidity and functional impairment are common, frailty measurement provides a tool for understanding how infection impacts future health beyond ... Full text Link to item Cite

The Social Risk ACTIONS Framework: Characterizing Responses to Social Risks by Health Care Delivery Organizations.

Journal Article Popul Health Manag · December 2024 Social risks refer to individuals' social and economic conditions shaped by underlying social determinants of health. Health care delivery organizations increasingly screen patients for social risks given their potential impact on health outcomes. However, ... Full text Link to item Cite

A comparison of time-varying propensity score vs sequential stratification approaches to longitudinal matching with a time-varying treatment.

Journal Article BMC Med Res Methodol · November 13, 2024 BACKGROUND: Methods for matching in longitudinal cohort studies, such as sequential stratification and time-varying propensity scores, facilitate causal inferences in the context of time-dependent treatments that are not randomized where patient eligibilit ... Full text Link to item Cite

Demographic, Social, Behavioral, and Clinical Characteristics Associated with Long-Term Opioid Therapy and Any Opioid Prescription in High-Risk VA Patients.

Journal Article J Gen Intern Med · October 22, 2024 BACKGROUND: Social risks (individual social and economic conditions) have been implicated as playing a major role in the opioid epidemic and may be more prevalent in the most medically vulnerable patients. However, the extent to which specific social risks ... Full text Link to item Cite

The association between social risks and days at home for older veterans.

Journal Article J Am Geriatr Soc · October 2024 BACKGROUND: Many health systems are trying to support the ability of older adults to remain in their homes for as long as possible. Little is known about the relationship between patient-reported social risks and length of time spent at home. We assessed h ... Full text Link to item Cite

Fall Outcomes in Older Adults Following Benzodiazepine/Z-Drug Discontinuation: A Retrospective Cohort Study in an Academic Health System.

Journal Article Drugs Aging · October 2024 BACKGROUND: Benzodiazepines and z-drugs increase the fall risk in older adults. There is a lack of real-world data examining the association between falls and deprescribing medications. OBJECTIVE: In a retrospective cohort study of older adults with chroni ... Full text Link to item Cite

Financial hardship after COVID-19 infection among US Veterans: a national prospective cohort study.

Journal Article BMC Health Serv Res · August 19, 2024 BACKGROUND: Research suggests an association between COVID-19 infection and certain financial hardships in the shorter term and among single-state and privately insured samples. Whether COVID-19 is associated with financial hardship in the longer-term or a ... Full text Link to item Cite

Trajectories of Physical Resilience Among Older Veterans With Stage 4 CKD.

Journal Article Am J Kidney Dis · August 2024 RATIONALE & OBJECTIVE: Although functional impairment is common among older adults with chronic kidney disease (CKD), functional reserve before an acute health event and physical resilience after the event have not been characterized in this population. Th ... Full text Link to item Cite

Association of Patient-Reported Social Needs with Emergency Department Visits and Hospitalizations Among Federally Qualified Health Center Patients.

Journal Article J Gen Intern Med · August 2024 BACKGROUND: Health care systems are increasingly screening for unmet social needs. The association between patient-reported social needs and health care utilization is not well understood. OBJECTIVE: To investigate the association between patient-reported ... Full text Link to item Cite

Impact of comprehensive medication reviews on potentially inappropriate medication discontinuation in Medicare beneficiaries.

Journal Article J Am Geriatr Soc · August 2024 BACKGROUND: The use of potentially inappropriate medications (PIMs) is associated with increased risk of hospitalizations and emergency room visits and varies by racial and ethnic subgroups. Medicare's nationwide medication therapy management (MTM) program ... Full text Link to item Cite

Requiem for odds ratios.

Journal Article Health Serv Res · August 2024 Full text Link to item Cite

Impact of SARS-CoV-2 Infection on Long-Term Depression Symptoms among Veterans.

Journal Article J Gen Intern Med · June 2024 BACKGROUND: Prior research demonstrates that SARS-COV-2 infection can be associated with a broad range of mental health outcomes including depression symptoms. Veterans, in particular, may be at elevated risk of increased depression following SARS-COV-2 in ... Full text Link to item Cite

Hospital response to a new case-based payment system in China: the patient selection effect.

Journal Article Health Policy Plan · May 15, 2024 Providers have intended and unintended responses to payment reforms, such as China's new case-based payment system, i.e. Diagnosis-Intervention Packet (DIP) under global budget, that classified patients based on the combination of principal diagnosis and p ... Full text Open Access Link to item Cite

Comprehensive Medication Review Completion Rates and Disparities After Medicare Star Rating Measure.

Journal Article JAMA Health Forum · May 3, 2024 IMPORTANCE: Comprehensive medication reviews (CMRs) are offered to qualifying US Medicare beneficiaries annually to optimize medication regimens and therapeutic outcomes. In 2016, Medicare adopted CMR completion as a Star Rating quality measure to encourag ... Full text Link to item Cite

Association Between a National Behavioral Weight Management Program and Veterans Affairs Health Expenditures.

Journal Article Med Care · April 1, 2024 OBJECTIVE: The association between participation in a behavioral weight intervention and health expenditures has not been well characterized. We compared Veterans Affairs (VA) expenditures of individuals participating in MOVE!, a VA behavioral weight loss ... Full text Link to item Cite

Risk of Potentially Preventable Hospitalizations After SARS-CoV-2 Infection.

Journal Article JAMA Netw Open · April 1, 2024 IMPORTANCE: Research demonstrates that SARS-CoV-2 infection is associated with increased risk of all-cause hospitalization. However, no prior studies have assessed the association between SARS-CoV-2 and potentially preventable hospitalizations-that is, hos ... Full text Link to item Cite

Self-Reported Everyday Functioning After COVID-19 Infection.

Journal Article JAMA Netw Open · March 4, 2024 IMPORTANCE: Changes in everyday functioning are crucial to assessing the long-term impact of COVID-19 infection. OBJECTIVE: To examine the impact of COVID-19 infection on everyday functioning 18 months after infection among veterans with and without histor ... Full text Link to item Cite

Risk of Suicide-Related Outcomes After SARS-COV-2 Infection: Results from a Nationwide Observational Matched Cohort of US Veterans.

Journal Article J Gen Intern Med · March 2024 BACKGROUND: Negative mental health-related effects of SARS-COV-2 infection are increasingly evident. However, the impact on suicide-related outcomes is poorly understood, especially among populations at elevated risk. OBJECTIVE: To determine risk of suicid ... Full text Link to item Cite

Real World Use of Anti-Obesity Medications and Weight Change in Veterans.

Journal Article J Gen Intern Med · March 2024 BACKGROUND: Anti-obesity medications (AOMs) can be initiated in conjunction with participation in the VA national behavioral weight management program, MOVE!, to help achieve clinically meaningful weight loss. OBJECTIVE: To compare weight change between Ve ... Full text Link to item Cite

Changes in Outpatient Health Care Use After COVID-19 Infection Among Veterans.

Journal Article JAMA Netw Open · February 5, 2024 IMPORTANCE: The association of COVID-19 infection with outpatient care utilization is unclear. Many studies reported population surveillance studies rather than comparing outpatient health care use between COVID-19-infected and uninfected cohorts. OBJECTIV ... Full text Link to item Cite

Association between patient-reported social and behavioral risks and health care costs in high-risk Veterans health administration patients.

Journal Article Health Serv Res · February 2024 OBJECTIVE: Social risks complicate patients' ability to manage their conditions and access healthcare, but their association with health expenditures is not well established. To identify patient-reported social risk, behavioral, and health factors associat ... Full text Link to item Cite

Evaluating the Safety of an Educational Deprescribing Intervention: Lessons from the Optimize Trial.

Journal Article Drugs Aging · January 2024 BACKGROUND: Patients, family members, and clinicians express concerns about potential adverse drug withdrawal events (ADWEs) following medication discontinuation or fears of upsetting a stable medical equilibrium as key barriers to deprescribing. Currently ... Full text Link to item Cite

Differences in healthcare costs over 10 years following discharge from military service by weight trajectory.

Journal Article Obes Res Clin Pract · 2024 The prevalence of overweight and obesity among military personnel has increased substantially in the past two decades. Following military discharge many personnel can receive integrated health care from the Veterans Health Administration. Prior research re ... Full text Link to item Cite

Association between a national behavioral weight management program and real-world weight change.

Journal Article Obes Res Clin Pract · 2024 OBJECTIVE: In a national cohort of Veterans, weight change was compared between participants in a US Department of Veterans Affairs (VA) behavioral weight management program (MOVE!) and matched non-participants, and between high-intensity and low-intensity ... Full text Link to item Cite

Patient education and extracorporeal membrane oxygenation preferences of patients and providers in COVID care.

Journal Article PLoS One · 2024 BACKGROUND: Extracorporeal membrane oxygenation (ECMO) represents an important but limited treatment for patients with severe COVID-19. We assessed the effects of an educational intervention on a person's ECMO care preference and examined whether patients ... Full text Link to item Cite

Rates of ICD-10 Code U09.9 Documentation and Clinical Characteristics of VA Patients With Post-COVID-19 Condition.

Journal Article JAMA Netw Open · December 1, 2023 IMPORTANCE: A significant proportion of SARS-CoV-2 infected individuals experience post-COVID-19 condition months after initial infection. OBJECTIVE: To determine the rates, clinical setting, risk factors, and symptoms associated with the documentation of ... Full text Link to item Cite

Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans.

Journal Article J Gen Intern Med · November 2023 BACKGROUND: Social risks contribute to poor health outcomes, especially for patients with complex medical needs. These same risks may impact access to primary care services. OBJECTIVE: To study associations between social risks and primary care utilization ... Full text Link to item Cite

Effectiveness of Nirmatrelvir-Ritonavir Against the Development of Post-COVID-19 Conditions Among U.S. Veterans : A Target Trial Emulation.

Journal Article Ann Intern Med · November 2023 BACKGROUND: COVID-19 has been linked to the development of many post-COVID-19 conditions (PCCs) after acute infection. Limited information is available on the effectiveness of oral antivirals used to treat acute COVID-19 in preventing the development of PC ... Full text Link to item Cite

Bariatric Surgery and Suicide Risk in Patients With Obesity.

Journal Article Ann Surg · October 1, 2023 OBJECTIVE: In a large multisite cohort of Veterans who underwent Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy, we compared the 5-year suicidal ideation and attempt rates with matched nonsurgical controls. BACKGROUND: Bariatric surgery has si ... Full text Link to item Cite

Late Mortality After COVID-19 Infection Among US Veterans vs Risk-Matched Comparators: A 2-Year Cohort Analysis.

Journal Article JAMA Intern Med · October 1, 2023 IMPORTANCE: Despite growing evidence of persistent problems after acute COVID-19, how long the excess mortality risk associated with COVID-19 persists is unknown. OBJECTIVE: To measure the time course of differential mortality among Veterans who had a firs ... Full text Link to item Cite

Epidemiology of Community-Acquired Acute Kidney Injury Among US Veterans.

Journal Article Am J Kidney Dis · September 2023 RATIONALE & OBJECTIVE: Community-acquired acute kidney injury (CA-AKI) develops outside of the hospital and is the most common form of AKI globally. National estimates of CA-AKI in the United States are absent due to limited availability of laboratory data ... Full text Link to item Cite

Costs Associated With Progression of Mildly Reduced Kidney Function Among Medicare Advantage Enrollees.

Journal Article Kidney Med · June 2023 RATIONALE & OBJECTIVE: The prevalence of early chronic kidney disease (CKD) in older adults has increased in the past 2 decades, yet CKD disease progression, overall, is variable. It is unclear whether health care costs differ by progression trajectory. Th ... Full text Link to item Cite

Effectiveness of COVID-19 Treatment With Nirmatrelvir-Ritonavir or Molnupiravir Among U.S. Veterans: Target Trial Emulation Studies With One-Month and Six-Month Outcomes.

Journal Article Ann Intern Med · June 2023 BACKGROUND: Information about the effectiveness of oral antivirals in preventing short- and long-term COVID-19-related outcomes in the setting of Omicron variant transmission and COVID-19 vaccination is limited. OBJECTIVE: To measure the effectiveness of n ... Full text Link to item Cite

Adverse outcomes of SARS-CoV-2 infection with delta and omicron variants in vaccinated versus unvaccinated US veterans: retrospective cohort study.

Journal Article BMJ · May 23, 2023 OBJECTIVES: To determine the association between covid-19 vaccination types and doses with adverse outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection during the periods of delta (B.1.617.2) and omicron (B.1.1.529) variant pr ... Full text Link to item Cite

BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge.

Journal Article J Gen Intern Med · May 2023 BACKGROUND: Obesity (body mass index [BMI]≥30kg/m2) among US adults has tripled over the past 45 years, but it is unclear how this population-level weight change has occurred. OBJECTIVE: We sought to identify distinct long-term BMI trajectories and examine ... Full text Link to item Cite

Design and analysis of outcomes following SARS-CoV-2 infection in veterans.

Journal Article BMC Med Res Methodol · April 4, 2023 BACKGROUND: Understanding how SARS-CoV-2 infection impacts long-term patient outcomes requires identification of comparable persons with and without infection. We report the design and implementation of a matching strategy employed by the Department of Vet ... Full text Link to item Cite

Association between patient-reported social, behavioral, and health factors and emergency department visits in high-risk VA patients.

Journal Article Health Serv Res · April 2023 RESEARCH OBJECTIVE: To identify patient-reported social risk, behavioral, and health factors associated with emergency department (ED) utilization in high-risk Veterans Affairs (VA) patients. DATA SOURCES: Patient survey, VA, Medicare data. STUDY DESIGN: P ... Full text Link to item Cite

Intervention design in cognitively impaired populations-Lessons learned from the OPTIMIZE deprescribing pragmatic trial.

Journal Article J Am Geriatr Soc · March 2023 BACKGROUND: Polypharmacy is common in older adults with cognitive impairment and multiple chronic conditions, increasing risks of adverse drug events, hospitalization, and death. Deprescribing, the process of reducing or stopping potentially inappropriate ... Full text Link to item Cite

Have racial disparities in home dialysis utilization changed over time?

Journal Article Am J Manag Care · March 2023 OBJECTIVES: The Medicare end-stage kidney disease (ESKD) prospective payment system (PPS) for maintenance dialysis, implemented in 2011, resulted in modestly increased access to both home-based peritoneal dialysis (PD) and home hemodialysis (HHD) treatment ... Full text Link to item Cite

Rates of and Factors Associated With Primary and Booster COVID-19 Vaccine Receipt by US Veterans, December 2020 to June 2022.

Journal Article JAMA Netw Open · February 1, 2023 IMPORTANCE: COVID-19 vaccination rates remain suboptimal in the US. Identifying factors associated with vaccination can highlight existing gaps and guide targeted interventions to improve vaccination access and uptake. OBJECTIVE: To describe incidence and ... Full text Link to item Cite

Willingness of older people living with dementia and mild cognitive impairment and their caregivers to have medications deprescribed.

Journal Article Age Ageing · January 8, 2023 BACKGROUND: people living with cognitive impairment commonly take multiple medications including potentially inappropriate medications (PIMs), which puts them at risk of medication related harms. AIMS: to explore willingness to have a medication deprescrib ... Full text Link to item Cite

Understanding care coordination for Veterans with complex care needs: protocol of a multiple-methods study to build evidence for an effectiveness and implementation study

Journal Article Frontiers in Health Services · January 1, 2023 Background: For patients with complex health and social needs, care coordination is crucial for improving their access to care, clinical outcomes, care experiences, and controlling their healthcare costs. However, evidence is inconsistent regarding the cor ... Full text Cite

Reserve and resilience in CKD: concept introduction and baseline results from the Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study.

Journal Article BMC Nephrol · December 31, 2022 BACKGROUND: The purpose of this manuscript is to introduce reserve and resilience as novel concepts in chronic kidney disease (CKD) research and present baseline data from a unique prospective cohort study designed to characterize recovery from functional ... Full text Link to item Cite

Effectiveness of COVID-19 treatment with nirmatrelvir-ritonavir or molnupiravir among U.S. Veterans: target trial emulation studies with one-month and six-month outcomes.

Journal Article medRxiv · December 16, 2022 BACKGROUND: Information about the effectiveness of oral antivirals in preventing short- and long-term COVID-19-related outcomes during the Omicron surge is limited. We sought to determine the effectiveness of nirmatrelvir-ritonavir and molnupiravir for the ... Full text Link to item Cite

Effectiveness of mRNA COVID-19 Vaccine Boosters Against Infection, Hospitalization, and Death: A Target Trial Emulation in the Omicron (B.1.1.529) Variant Era.

Journal Article Ann Intern Med · December 2022 BACKGROUND: The effectiveness of a third mRNA COVID-19 vaccine dose (booster dose) against the Omicron (B.1.1.529) variant is uncertain, especially in older, high-risk populations. OBJECTIVE: To determine mRNA booster vaccine effectiveness (VE) against SAR ... Full text Link to item Cite

Association between Gentrification and Health and Healthcare Utilization.

Journal Article J Urban Health · December 2022 There is tremendous interest in understanding how neighborhoods impact health by linking extant social and environmental drivers of health (SDOH) data with electronic health record (EHR) data. Studies quantifying such associations often use static neighbor ... Full text Link to item Cite

Consensus elements for observational research on COVID-19-related long-term outcomes.

Journal Article Medicine (Baltimore) · November 18, 2022 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and its long-term outcomes may be jointly caused by a wide range of clinical, social, and economic characteristics. Studies aiming to identify mechanisms for SARS-CoV-2 morbidity and mo ... Full text Link to item Cite

Complexity and Challenges of the Clinical Diagnosis and Management of Long COVID.

Journal Article JAMA Netw Open · November 1, 2022 IMPORTANCE: There is increasing recognition of the long-term health effects of SARS-CoV-2 infection (sometimes called long COVID). However, little is yet known about the clinical diagnosis and management of long COVID within health systems. OBJECTIVE: To d ... Full text Link to item Cite

Early Adoption of Anti-SARS-CoV-2 Pharmacotherapies Among US Veterans With Mild to Moderate COVID-19, January and February 2022.

Journal Article JAMA Netw Open · November 1, 2022 IMPORTANCE: Older adults and individuals with medical comorbidities are at increased risk for severe COVID-19. Several pharmacotherapies demonstrated to reduce the risk of COVID-19-related hospitalization and death have been authorized for use. OBJECTIVE: ... Full text Link to item Cite

263 INFORMING INTERVENTION DESIGN IN COGNITIVELY IMPAIRED POPULATIONS: LESSONS LEARNED FROM THE OPTIMIZE DEPRESCRIBING INTERVENTION

Conference Age and Ageing · October 25, 2022 AbstractBackgroundPolypharmacy is common in older adults with cognitive impairment and multiple chronic conditions increasing their ri ... Full text Cite

Improving Prediction of Long-Term Care Utilization Through Patient-Reported Measures: Cross-Sectional Analysis of High-Need U.S. Veterans Affairs Patients.

Journal Article Med Care Res Rev · October 2022 This article examines the relative merit of augmenting an electronic health record (EHR)-derived predictive model of institutional long-term care (LTC) use with patient-reported measures not commonly found in EHRs. We used survey and administrative data fr ... Full text Link to item Cite

Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control: A Randomized Clinical Trial.

Journal Article JAMA Intern Med · September 1, 2022 IMPORTANCE: Persistently poorly controlled type 2 diabetes (PPDM) is common and causes poor outcomes. Comprehensive telehealth interventions could help address PPDM, but effectiveness is uncertain, and barriers impede use in clinical practice. OBJECTIVE: T ... Full text Open Access Link to item Cite

Rates of Medicare Enrollment Among Dialysis Patients After Implementation of Medicare Payment Reform and the Affordable Care Act Marketplace.

Journal Article JAMA Netw Open · September 1, 2022 IMPORTANCE: Medicare finances health care for most US patients with end-stage kidney disease (ESKD), regardless of age. The 2011 Medicare prospective payment system (PPS) for dialysis reduced reimbursement for hemodialysis, and the 2014 Patient Protection ... Full text Link to item Cite

Clinical Outcome and Utilization Profiles Among Latent Groups of High-Risk Patients: Moving from Segmentation Towards Intervention.

Journal Article J Gen Intern Med · August 2022 BACKGROUND: The ability of latent class models to identify clinically distinct groups among high-risk patients has been demonstrated, but it is unclear how healthcare data can inform group-specific intervention design. OBJECTIVE: Examine how utilization pa ... Full text Link to item Cite

Outpatient care fragmentation in Veterans Affairs patients at high-risk for hospitalization.

Journal Article Health Serv Res · August 2022 OBJECTIVE: To examine outpatient care fragmentation and its association with future hospitalization among patients at high risk for hospitalization. DATA SOURCES: Veterans Affairs (VA) and Medicare data. STUDY DESIGN: We conducted a longitudinal study, usi ... Full text Link to item Cite

The Effect of Bariatric Surgery on Long-term Depression Treatment in Patients With Obesity.

Journal Article Ann Surg · August 1, 2022 OBJECTIVE: In a large multisite cohort of Veterans who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (LSG), initiation of (ie, incident) and persistence of (ie, continuation of preoperative) depression treatment are compared ... Full text Link to item Cite

Rates and Factors Associated With Documentation of Diagnostic Codes for Long COVID in the National Veterans Affairs Health Care System.

Journal Article JAMA Netw Open · July 1, 2022 IMPORTANCE: Some persons infected with SARS-CoV-2 experience symptoms or impairments many months after acute infection. OBJECTIVES: To determine the rates, clinical setting, and factors associated with documented receipt of COVID-19-related care 3 or more ... Full text Link to item Cite

Factors associated with non-adherence to insulin and non-insulin medications in patients with poorly controlled diabetes.

Journal Article Chronic Illn · June 2022 OBJECTIVES: To evaluate differences in factors associated with self-reported medication non-adherence to insulin and non-insulin medications in patients with uncontrolled type 2 diabetes. METHODS: In this secondary analysis of a randomized trial in patient ... Full text Link to item Cite

Deprescribing Education vs Usual Care for Patients With Cognitive Impairment and Primary Care Clinicians: The OPTIMIZE Pragmatic Cluster Randomized Trial.

Journal Article JAMA Intern Med · May 1, 2022 BACKGROUND: Individuals with dementia or mild cognitive impairment frequently have multiple chronic conditions (defined as ≥2 chronic medical conditions) and take multiple medications, increasing their risk for adverse outcomes. Deprescribing (reducing or ... Full text Link to item Cite

Unintended Consequences of COVID-19 Social Distancing Among Older Adults With Kidney Disease.

Journal Article J Gerontol A Biol Sci Med Sci · April 1, 2022 BACKGROUND: While social distancing policies protect older adults with advanced chronic kidney disease (CKD) from exposure to COVID-19, reduced social interaction may also have unintended consequences. METHODS: To identify subgroups of patients at risk for ... Full text Link to item Cite

Primary Care Physicians', Psychiatrists', and Oncologists' Coordination While Prescribing Medications for Patients With Multiple Chronic Conditions.

Journal Article J Patient Saf · March 1, 2022 OBJECTIVES: Coordination of medication prescribing is important in the care of patients with multiple chronic conditions (MCC) given the involvement of multiple providers and multiple medications used to manage MCC. The objective of this study was to ident ... Full text Link to item Cite

Does Long-Term Post-Bariatric Weight Change Differ Across Antidepressants?

Journal Article Ann Surg Open · March 2022 UNLABELLED: We sought to evaluate whether weight change up to 5 years after bariatric surgery differed by antidepressant class taken before surgery. BACKGROUND: Bariatric surgery induces significant weight loss, but outcomes are highly variable. The specif ... Full text Link to item Cite

Clinical associations of an updated medication effect score for measuring diabetes treatment intensity.

Journal Article Chronic Illn · December 2021 OBJECTIVES: The medication effect score reflects overall intensity of a diabetes regimen by consolidating dosage and potency of agents used. Little is understood regarding how medication intensity relates to clinical factors. We updated the medication effe ... Full text Link to item Cite

Which patients benefit most from completing health risk assessments: comparing methods to identify heterogeneity of treatment effects

Journal Article Health Services and Outcomes Research Methodology · December 1, 2021 Methods for identifying heterogeneity of treatment effects in randomized trials have seen recent advances, yet applying these methods to health services intervention trials has not been well investigated. Our objective was to compare two approaches—predict ... Full text Cite

Whose value is it anyway? Reconciling conflicting perceptions of patients and payers.

Journal Article Healthc (Amst) · December 2021 A promising pathway to achieving greater value in health care is to increase use of "high-value" services and decrease use of "low-value" services. Sometimes the value judgments of patients and payers are well-aligned, creating opportunities for policymake ... Full text Link to item Cite

Heterogeneity of Treatment Effects Among Patients With Type 2 Diabetes and Elevated Body Mass Index in a Study Comparing Group Medical Visits Focused on Weight Management and Medication Intensification.

Journal Article Med Care · November 1, 2021 BACKGROUND: Illuminating heterogeneity of treatment effect (HTE) within trials is important for identifying target populations for implementation. OBJECTIVE: The aim of this study was to examine HTE in a trial of group medical visits (GMVs) for patients wi ... Full text Link to item Cite

Trends in Dialysis Industry Consolidation After Medicare Payment Reform, 2006-2016.

Journal Article JAMA Health Forum · November 2021 IMPORTANCE: The dialysis industry is highly concentrated, with large dialysis organizations now providing dialysis for more than 85% of patients with kidney failure in the United States. In 2011, Medicare introduced a new Prospective Payment System (PPS) f ... Full text Open Access Link to item Cite

Changes in the associations of race and rurality with SARS-CoV-2 infection, mortality, and case fatality in the United States from February 2020 to March 2021: A population-based cohort study.

Journal Article PLoS Med · October 2021 BACKGROUND: We examined whether key sociodemographic and clinical risk factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and mortality changed over time in a population-based cohort study. METHODS AND FINDINGS: In a cohort ... Full text Link to item Cite

Trends in Regional Supply of Peritoneal Dialysis in an Era of Health Reform, 2006 to 2013.

Journal Article Med Care Res Rev · June 2021 Peritoneal dialysis (PD), a home-based treatment for kidney failure, is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis. Yet <10% of patients receive PD. Access to this alternative treatment, vis-à-vis ... Full text Link to item Cite

The association of alcohol use with all-cause and cardiovascular disease-related hospitalizations or death in older, high-risk Veterans.

Journal Article Alcohol Clin Exp Res · June 2021 BACKGROUND: The prevalence of alcohol misuse among older adults has grown dramatically in the past decade, yet little is known about the association of alcohol misuse with hospitalization and death in this patient population. METHODS: We examined the assoc ... Full text Link to item Cite

Annual wellness visits and care management before and after dialysis initiation.

Journal Article BMC Nephrol · May 5, 2021 INTRODUCTION: Demands of dialysis regimens may pose challenges for primary care provider (PCP) engagement and timely preventive care. This is especially the case for patients initiating dialysis adjusting to new logistical challenges and management of symp ... Full text Link to item Cite

Subgroups of High-Risk Veterans Affairs Patients Based on Social Determinants of Health Predict Risk of Future Hospitalization.

Journal Article Med Care · May 1, 2021 OBJECTIVE: Population segmentation has been recognized as a foundational step to help tailor interventions. Prior studies have predominantly identified subgroups based on diagnoses. In this study, we identify clinically coherent subgroups using social dete ... Full text Link to item Cite

Comparing Mortality of Peritoneal and Hemodialysis Patients in an Era of Medicare Payment Reform.

Journal Article Med Care · February 1, 2021 BACKGROUND: Prior studies have shown peritoneal dialysis (PD) patients to have lower or equivalent mortality to patients who receive in-center hemodialysis (HD). Medicare's 2011 bundled dialysis prospective payment system encouraged expansion of home-based ... Full text Link to item Cite

Opioid Prescribing in the 2016 Medicare Fee-for-Service Population.

Journal Article J Am Geriatr Soc · February 2021 BACKGROUND AND OBJECTIVES: Opioid use and misuse are prevalent and remain a national crisis. This study identified beneficiary characteristics associated with filling opioid prescriptions, variation in opioid dosing, and opioid use with average daily doses ... Full text Link to item Cite

A Method to Quantify Mean Hypertension Treatment Daily Dose Intensity Using Health Care System Data.

Journal Article JAMA Netw Open · January 4, 2021 IMPORTANCE: Simple measures of hypertension treatment, such as achievement of blood pressure (BP) targets, ignore the intensity of treatment once the BP target is met. High-intensity treatment involves increased treatment burden and can be associated with ... Full text Link to item Cite

A machine learning approach to identify distinct subgroups of veterans at risk for hospitalization or death using administrative and electronic health record data.

Journal Article PLoS One · 2021 BACKGROUND: Identifying individuals at risk for future hospitalization or death has been a major priority of population health management strategies. High-risk individuals are a heterogeneous group, and existing studies describing heterogeneity in high-ris ... Full text Link to item Cite

Disparities in Chronic Kidney Disease Progression by Medicare Advantage Enrollees.

Journal Article Am J Nephrol · 2021 INTRODUCTION: The prevalence of chronic kidney disease (CKD) in Medicare beneficiaries has quadrupled in the past 2 decades, but little is known about risk factors affecting the progression of CKD. This study aims to understand the progression in Medicare ... Full text Link to item Cite

Designing a Primary Care-Based Deprescribing Intervention for Patients with Dementia and Multiple Chronic Conditions: a Qualitative Study.

Journal Article J Gen Intern Med · December 2020 BACKGROUND: Patients with dementia and multiple chronic conditions (MCC) frequently experience polypharmacy, increasing their risk of adverse drug events. OBJECTIVES: To elucidate patient, family, and physician perspectives on medication discontinuation an ... Full text Link to item Cite

Association of Bariatric Surgical Procedures With Changes in Unhealthy Alcohol Use Among US Veterans.

Journal Article JAMA Netw Open · December 1, 2020 IMPORTANCE: Bariatric surgical procedures have been associated with increased risk of unhealthy alcohol use, but no previous research has evaluated the long-term alcohol-related risks after laparoscopic sleeve gastrectomy (LSG), currently the most used bar ... Full text Link to item Cite

Association of VA Payment Reform for Dialysis with Spending, Access to Care, and Outcomes for Veterans with ESKD.

Journal Article Clin J Am Soc Nephrol · November 6, 2020 BACKGROUND AND OBJECTIVES: Because of the limited capacity of its own dialysis facilities, the Department of Veterans Affairs (VA) Veterans Health Administration routinely outsources dialysis care to community providers. Prior to 2011-when the VA implement ... Full text Link to item Cite

Practical telehealth to improve control and engagement for patients with clinic-refractory diabetes mellitus (PRACTICE-DM): Protocol and baseline data for a randomized trial.

Journal Article Contemp Clin Trials · November 2020 BACKGROUND: Persistent poorly-controlled type 2 diabetes mellitus (PPDM), or maintenance of a hemoglobin A1c (HbA1c) ≥8.5% despite receiving clinic-based diabetes care, contributes disproportionately to the national diabetes burden. Comprehensive telehealt ... Full text Open Access Link to item Cite

Patient-Reported Social and Behavioral Determinants of Health and Estimated Risk of Hospitalization in High-Risk Veterans Affairs Patients.

Journal Article JAMA Netw Open · October 1, 2020 IMPORTANCE: Despite recognition of the association between individual social and behavioral determinants of health (SDH) and patient outcomes, little is known regarding the value of SDH in explaining variation in outcomes for high-risk patients. OBJECTIVE: ... Full text Link to item Cite

A data-driven examination of which patients follow trial protocol.

Journal Article Contemp Clin Trials Commun · September 2020 UNLABELLED: Protocol adherence in behavioral intervention clinical trials is critical to trial success. There is increasing interest in understanding which patients are more likely to adhere to trial protocols. The objective of this study was to demonstrat ... Full text Link to item Cite

How comfortable are primary care physicians and oncologists prescribing medications for comorbidities in patients with cancer?

Journal Article Res Social Adm Pharm · August 2020 BACKGROUND: Treating cancer and existing chronic comorbidities requires a dynamic mix of primary care and specialist providers. However, little is known regarding primary care physicians' (PCPs) and oncologists' comfort level prescribing for comorbid condi ... Full text Link to item Cite

Long-term opioid use after bariatric surgery.

Journal Article Surg Obes Relat Dis · August 2020 BACKGROUND: Opioid analgesics are often prescribed to manage pain after bariatric surgery, which may develop into chronic prescription opioid use (CPOU) in opioid-naïve patients. Bariatric surgery may affect opioid use in those with or without presurgical ... Full text Link to item Cite

Regression Discontinuity Design.

Journal Article JAMA · July 28, 2020 Full text Link to item Cite

Validation of a Health System Measure to Capture Intensive Medication Treatment of Hypertension in the Veterans Health Administration.

Journal Article JAMA Netw Open · July 1, 2020 IMPORTANCE: Blood pressure (BP) targets are the main measure of high-quality hypertension care in health systems. However, BP alone does not reflect intensity of pharmacological treatment, which should be carefully managed in older patients. OBJECTIVES: To ... Full text Link to item Cite

The OPTIMIZE patient- and family-centered, primary care-based deprescribing intervention for older adults with dementia or mild cognitive impairment and multiple chronic conditions: study protocol for a pragmatic cluster randomized controlled trial.

Journal Article Trials · June 18, 2020 BACKGROUND: Most individuals with dementia or mild cognitive impairment (MCI) have multiple chronic conditions (MCC). The combination leads to multiple medications and complex medication regimens and is associated with increased risk for significant treatm ... Full text Link to item Cite

Short-Term VA Health Care Expenditures Following a Health Risk Assessment and Coaching Trial.

Journal Article J Gen Intern Med · May 2020 BACKGROUND: Short-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed. OBJECTIVE: To compare VA health care expenditures among veterans who participated in a behavioral intervention ... Full text Link to item Cite

Medicare Enrollment Among Patients With End-Stage Kidney Disease Receiving Dialysis in Outpatient Facilities Between 2005 and 2016.

Journal Article JAMA · April 7, 2020 This study characterizes annual changes in enrollment of Medicare and non-Medicare patients treated at dialysis facilities before and after 2011 payment reforms and 2014 Affordable Care Act changes that influenced reimbursements. ... Full text Link to item Cite

Care continuity impacts medicare expenditures of older adults: Fact or fiction?

Journal Article Healthc (Amst) · March 2020 BACKGROUND: Older adults with cardiometabolic conditions are typically seen by multiple providers. Management by multiple providers may compromise care continuity and increase health expenditures for older adults, which may partly explain the inverse assoc ... Full text Link to item Cite

Risk Factors and Outcomes of Opioid Users with and Without Concurrent Benzodiazepine Use in the North Carolina Medicaid Population.

Journal Article J Manag Care Spec Pharm · February 2020 BACKGROUND: Concurrent use of opioids and benzodiazepines is associated with increased risk of opioid overdose and death. Clinical guidelines recommend against this practice and quality measures incentivize plans to minimize concurrent use. OBJECTIVE: To c ... Full text Link to item Cite

Comparison of Group Medical Visits Combined With Intensive Weight Management vs Group Medical Visits Alone for Glycemia in Patients With Type 2 Diabetes: A Noninferiority Randomized Clinical Trial.

Journal Article JAMA Intern Med · January 1, 2020 IMPORTANCE: Traditionally, group medical visits (GMVs) for persons with diabetes improved glycemia by intensifying medications, which infrequently led to weight loss. Incorporating GMVs with intensive dietary change could enable weight loss and improve gly ... Full text Link to item Cite

Quasi-experimental design

Journal Article Biostatistics and Epidemiology · January 1, 2020 Quasi-experiments are similar to randomized controlled trials in many respects, but there are many challenges in designing and conducting a quasi-experiment when internal validity threats are introduced from the absence of randomization. This paper outline ... Full text Cite

Trends in Peritoneal Dialysis Use in the United States after Medicare Payment Reform.

Journal Article Clin J Am Soc Nephrol · December 6, 2019 BACKGROUND AND OBJECTIVES: Peritoneal dialysis (PD) for ESKD is associated with similar mortality, higher quality of life, and lower costs compared with hemodialysis (HD), but has historically been underused. We assessed the effect of the 2011 Medicare pro ... Full text Link to item Cite

Association Between Bariatric Surgery and Long-term Health Care Expenditures Among Veterans With Severe Obesity.

Journal Article JAMA Surg · December 1, 2019 IMPORTANCE: Bariatric surgery has been associated with improvements in health in patients with severe obesity; however, it is unclear whether these health benefits translate into lower health care expenditures. OBJECTIVE: To examine 10-year health care exp ... Full text Link to item Cite

Lab-based and diagnosis-based chronic kidney disease recognition and staging concordance.

Journal Article BMC Nephrol · September 14, 2019 BACKGROUND: Chronic kidney disease (CKD) is often under-recognized and poorly documented via diagnoses, but the extent of under-recognition is not well understood among Medicare beneficiaries. The current study used claims-based diagnosis and lab data to e ... Full text Link to item Cite

Time Horizons in Cost Analyses-Reply.

Journal Article JAMA · August 13, 2019 Full text Link to item Cite

Predicting Primary Care Use Among Patients in a Large Integrated Health System: The Role of Patient Experience Measures.

Journal Article Med Care · August 2019 OBJECTIVE: Most Veterans Affairs (VA) Health Care System enrollees age 65+ also have the option of obtaining care through Medicare. Reliance upon VA varies widely and there is a need to optimize its prediction in an era of expanding choice for veterans to ... Full text Link to item Cite

Authors' Reply.

Journal Article J Am Soc Nephrol · July 2019 Full text Link to item Cite

329-OR: Shared Medical Appointments (SMA) with Weight Management vs. SMA Alone for Overweight or Obese Patients with Type 2 Diabetes

Conference Diabetes · June 1, 2019 Background: Shared medical appointments (SMA) improve outcomes in diabetes. SMAs often address lifestyle but infrequently lead to weight loss. Because weight loss reduces glycemia and medication use, we hypothesized an SMA intervention with weight ... Full text Cite

Early Impact of the Patient Protection and Affordable Care Act on Delivery of Children's Surgical Care.

Journal Article Clin Pediatr (Phila) · April 2019 The impact of the Patient Protection and Affordable Care Act (PPACA) on children's access to surgical care is not well-defined. Our objective was to describe the early impact of PPACA on children's surgical care before and after Medicaid expansion in 2014. ... Full text Link to item Cite

Measuring the burden of multimorbidity among Medicare beneficiaries via condition counts and cumulative duration.

Journal Article Health Serv Res · April 2019 OBJECTIVE: The study's purpose was to describe the cumulative duration of 19 chronic conditions among Medicare fee-for-service (FFS) beneficiaries and examine variation in total expenditures explained by cumulative duration and condition counts. DESIGN, SE ... Full text Link to item Cite

Abstract 017: Impact of Gentrification on Cardiovascular Disease Surveillance Using Data from the Electronic Health Record

Conference Circulation · March 5, 2019 Introduction: Current static approaches of CVD surveillance may not capture the true health of neighborhoods as the influx of younger, healthier, and wealthier individuals (i.e., gentrification) can i ... Full text Cite

Spillover Effects of Massachusetts Health Reform on Mental Health Use by VA and Medicare Dual Enrollees.

Journal Article Adm Policy Ment Health · March 2019 Older veterans can obtain care from the Veterans Affairs Health System (VA), Medicare or both. We examined whether their use of mental health care was impacted by capacity effects stemming from younger, uninsured veterans' enrolling in VA to satisfy the in ... Full text Link to item Cite

Comprehensive Support for Family Caregivers: Impact on Veteran Health Care Utilization and Costs.

Journal Article Med Care Res Rev · February 2019 This study aimed to examine the early impact of the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on Veteran health care utilization and costs. A pre-post cohort design including a nonequivalent control group was used to understand how ... Full text Link to item Cite

Geographic Variation in Obesity, Behavioral Treatment, and Bariatric Surgery for Veterans.

Journal Article Obesity (Silver Spring) · January 2019 OBJECTIVE: This study aims to describe geographic variation in veterans' prevalence of obesity, participation in Veterans Health Administration's behavioral weight management program (MOVE!), and receipt of bariatric surgery in fiscal year (FY) 2016. METHO ... Full text Link to item Cite

Survival among Veterans Obtaining Dialysis in VA and Non-VA Settings.

Journal Article J Am Soc Nephrol · January 2019 BACKGROUND: Outcomes of veterans with ESRD may differ depending on where they receive dialysis and who finances this care, but little is known about variation in outcomes across different dialysis settings and financial arrangements. METHODS: We examined s ... Full text Link to item Cite

Medicare's New Prospective Payment System on Facility Provision of Peritoneal Dialysis.

Journal Article Clin J Am Soc Nephrol · December 7, 2018 BACKGROUND AND OBJECTIVES: Peritoneal dialysis is a self-administered, home-based treatment for ESKD associated with equivalent mortality, higher quality of life, and lower costs compared with hemodialysis. In 2011, Medicare implemented a comprehensive pro ... Full text Link to item Cite

Comparative Assessment of Utilization and Hospital Outcomes of Veterans Receiving VA and Non-VA Outpatient Dialysis.

Journal Article Health Serv Res · December 2018 OBJECTIVE: Growing demand for VA dialysis exceeds its supply and travel distances prohibit many Veterans from receiving dialysis in a VA facility, leading to increased use of dialysis from non-VA providers. This study compared utilization and hospitalizati ... Full text Link to item Cite

HSR Commentary: Linking VA and Non-VA Data to Address Important US Veteran Health Services Research Issues.

Journal Article Health Serv Res · December 2018 This commentary summarizes the methods and topics addressed in the special issue of HSR focused on linkage of United States Department of Veterans Affairs (VA) and non-VA datasets. The issue illustrates that researchers are increasingly linking diverse dat ... Full text Link to item Cite

Odds Ratios vs Risk Ratios-Reply.

Journal Article JAMA · November 20, 2018 Full text Link to item Cite

Lower Urinary Tract Symptoms in Older Children With and Without Diabetes Mellitus.

Journal Article Clin Pediatr (Phila) · November 2018 Lower urinary tract symptoms (LUTS) are an underrecognized complication of diabetes mellitus (DM) in adults and have undergone limited investigation in children. We estimated the prevalence of LUTS in 120 older children (11-17 years) with and without DM an ... Full text Link to item Cite

Results From a Trial of an Online Diabetes Prevention Program Intervention.

Journal Article Am J Prev Med · November 2018 INTRODUCTION: Online Diabetes Prevention Programs (DPPs) can be scaled up and delivered broadly. However, little is known about real-world effectiveness and how outcomes compare with in-person DPP. This study examined online DPP weight loss and participati ... Full text Link to item Cite

Update on the Health Services Research Doctoral Core Competencies.

Journal Article Health Serv Res · October 2018 OBJECTIVE: To present revised core competencies for doctoral programs in health services research (HSR), modalities to deliver these competencies, and suggested methods for assessing mastery of these competencies. DATA SOURCES AND DATA COLLECTION: Core com ... Full text Link to item Cite

Modeling Semicontinuous Longitudinal Expenditures: A Practical Guide.

Journal Article Health Serv Res · August 2018 OBJECTIVE: To compare different strategies for analyzing longitudinal expenditure data that have a point mass at $0. We provide guidance on parameter interpretation, research questions, and model selection. DATA SOURCES, STUDY DESIGN, AND DATA COLLECTION: ... Full text Link to item Cite

Patient-Centered Medical Home Implementation and Improved Chronic Disease Quality: A Longitudinal Observational Study.

Journal Article Health Serv Res · August 2018 OBJECTIVE: To examine associations between clinics' extent of patient-centered medical home (PCMH) implementation and improvements in chronic illness care quality. DATA SOURCE: Data from 808 Veterans Health Administration (VHA) primary care clinics nationw ... Full text Link to item Cite

The Effect of Support and Training for Family Members on Access to Outpatient Services for Veterans with Posttraumatic Stress Disorder (PTSD).

Journal Article Adm Policy Ment Health · July 2018 The VA Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides landmark support for family caregivers of post-9/11 veterans. This study examines PCAFC support for veterans with and without PTSD and assesses whether program effect differs ... Full text Link to item Cite

Working smarter not harder: Coupling implementation to de-implementation.

Journal Article Healthc (Amst) · June 2018 In this paper, we discuss de-implementation as an implicit part of implementation and organizational change, and consider its underlying processes of unlearning to discontinue or deviate from ineffective practice and learning to applying newer, more effect ... Full text Link to item Cite

Systematic Review of Behavioral Weight Management Program MOVE! for Veterans.

Journal Article Am J Prev Med · May 2018 CONTEXT: Since 2006, the Veterans Health Administration has delivered a population-based behavioral weight management program (MOVE!) to Veterans, which numerous studies have examined. The purpose of this study was to systematically review these studies to ... Full text Link to item Cite

Continuity of Medication Management among Adults with Schizophrenia and Comorbid Cardiometabolic Conditions.

Journal Article J Pharm Health Serv Res · March 2018 OBJECTIVES: Adults with schizophrenia and cardiometabolic conditions may be good candidates for co-management by primary care prescribers and specialists. Associated risks for discontinuity in medication management have not been well-studied. This study ex ... Full text Link to item Cite

Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use?

Journal Article Med Care Res Rev · February 2018 Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study ... Full text Link to item Cite

Taxes and Sugar-Sweetened Beverages.

Journal Article JAMA · January 16, 2018 Full text Link to item Cite

Overtreatment and Deintensification of Diabetic Therapy among Medicare Beneficiaries.

Journal Article J Gen Intern Med · January 2018 BACKGROUND: Deintensification of diabetic therapy is often clinically appropriate for older adults, because the benefit of aggressive diabetes treatment declines with age, while the risks increase. OBJECTIVE: We examined rates of overtreatment and deintens ... Full text Link to item Cite

Prescriber continuity and medication availability in older adults with cardiometabolic conditions.

Journal Article SAGE Open Med · 2018 BACKGROUND: Many older adults have multiple conditions and see multiple providers, which may impact their use of essential medications. OBJECTIVE: We examined whether the number of prescribers of these medications was associated with the availability of me ... Full text Open Access Link to item Cite

Using item response theory with health system data to identify latent groups of patients with multiple health conditions.

Journal Article PLoS One · 2018 A critical step toward tailoring effective interventions for heterogeneous and medically complex patients is to identify clinically meaningful subgroups on the basis of their comorbid conditions. We applied Item Response Theory (IRT), a potentially useful ... Full text Link to item Cite

Two parts are better than one: modeling marginal means of semicontinuous data

Journal Article Health Services and Outcomes Research Methodology · December 1, 2017 In health services research, it is common to encounter semicontinuous data characterized by a point mass at zero followed by a continuous distribution with positive support. These are often analyzed using two-part mixtures that separately model the probabi ... Full text Cite

A marginalized two-part model for longitudinal semicontinuous data.

Journal Article Stat Methods Med Res · August 2017 In health services research, it is common to encounter semicontinuous data, characterized by a point mass at zero followed by a right-skewed continuous distribution with positive support. Examples include health expenditures, in which the zeros represent a ... Full text Link to item Cite

Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA).

Journal Article Implement Sci · July 26, 2017 BACKGROUND: The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP vi ... Full text Link to item Cite

Diabetes Prevention Program Translation in the Veterans Health Administration.

Journal Article Am J Prev Med · July 2017 INTRODUCTION: This clinical demonstration trial compared the effectiveness of the Veterans Affairs Diabetes Prevention Program (VA-DPP) with an evidence-based usual care weight management program (MOVE!®) in the Veterans Health Administration health system ... Full text Link to item Cite

Jump starting shared medical appointments for diabetes with weight management: Rationale and design of a randomized controlled trial.

Journal Article Contemp Clin Trials · July 2017 BACKGROUND: Rates of glycemic control remain suboptimal nationwide. Medication intensification for diabetes can have undesirable side effects (weight gain, hypoglycemia), which offset the benefits of glycemic control. A Shared Medical Appointment (SMA) int ... Full text Link to item Cite

Comparative effectiveness of primary bariatric operations in the United States.

Journal Article Surg Obes Relat Dis · May 2017 BACKGROUND: Four current bariatric operations were compared after matching patients for differences at baseline. Operations with greater weight loss and resolution of co-morbidities also incurred more adverse events. Reflux was best treated by gastric bypa ... Full text Link to item Cite

Maintenance of Weight Loss After Initiation of Nutrition Training: A Randomized Trial.

Journal Article Ann Intern Med · April 4, 2017 BACKGROUND: Weight regain after successful weight loss interventions is common. OBJECTIVE: To establish the efficacy of a weight loss maintenance program compared with usual care in obese adults. DESIGN: 2-group, parallel, randomized trial stratified by in ... Full text Link to item Cite

Maintaining Weight Loss.

Journal Article Ann Intern Med · April 4, 2017 Full text Link to item Cite

Prescriber Continuity and Disease Control of Older Adults.

Journal Article Med Care · April 2017 BACKGROUND: Medicare beneficiaries with multiple chronic conditions are typically seen by multiple providers, particularly specialists. Clinically appropriate referrals to multiple specialists may compromise the continuity of care for multiple chronic cond ... Full text Link to item Cite

A Health Services Research Agenda for Bariatric Surgery Within the Veterans Health Administration.

Journal Article J Gen Intern Med · April 2017 In 2016, the Veterans Health Administration (VHA) held a Weight Management State of the Art conference to identify evidence gaps and develop a research agenda for population-based weight management for veterans. Included were behavioral, pharmacologic, and ... Full text Link to item Cite

A System-Level Approach to Overweight and Obesity in the Veterans Health Administration.

Journal Article J Gen Intern Med · April 2017 Healthcare systems are challenged by steady increases in the number of patients who are overweight and obese. Large-scale, evidence-based behavioral approaches for addressing overweight and obesity have been successfully implemented in systems such as the ... Full text Link to item Cite

Comparative Effectiveness of Wellness Programs: Impact of Incentives on Healthcare Costs for Obese Enrollees.

Journal Article Am J Prev Med · March 2017 INTRODUCTION: Employee wellness programs show mixed effectiveness results. This study examined the impact of an insurer's lifestyle modification program on healthcare costs of obese individuals. METHODS: This nonrandomized comparative effectiveness study e ... Full text Link to item Cite

Effect of Medicaid Policy Changes on Medication Adherence: Differences by Baseline Adherence.

Journal Article J Manag Care Spec Pharm · March 2017 BACKGROUND: In 2001, the North Carolina (NC) Medicaid program reduced the number of days prescription supply that enrollees could fill from 100 days to 34 days and increased copayments for brand-name medications. Previous work has shown that a change in th ... Full text Link to item Cite

Impacts of Geographic Distance on Peritoneal Dialysis Utilization: Refining Models of Treatment Selection.

Journal Article Health Serv Res · February 2017 OBJECTIVE: To examine the relationship between distance to dialysis provider and patient selection of dialysis modality, informed by the absolute distance from a patient's home and relative distance of alternative modalities. DATA SOURCES: U.S. Renal Data ... Full text Link to item Cite

Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status.

Journal Article Gen Hosp Psychiatry · 2017 OBJECTIVE: Patients with serious mental illness (SMI) often have comorbid cardiometabolic conditions (CMCs) that may increase the number of prescribers involved in treatment. This study examined whether patients with SMI (depression and schizophrenia) and ... Full text Link to item Cite

Characterization of Mineralocorticoid Receptor Antagonist Therapy Initiation in High-Risk Patients With Heart Failure.

Journal Article Circ Cardiovasc Qual Outcomes · January 2017 BACKGROUND: Heart failure guidelines recommend routine monitoring of serum potassium, and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). How these recommendations are implemented in high-risk patients or according to ... Full text Link to item Cite

Recruitment and Retention for a Weight Loss Maintenance Trial Involving Weight Loss Prior to Randomization.

Journal Article Obes Sci Pract · December 2016 OBJECTIVE: A weight loss maintenance trial involving weight loss prior to randomization is challenging to implement due to the potential for dropout and insufficient weight loss. We examined rates and correlates of non-initiation, dropout, and insufficient ... Full text Link to item Cite

Bariatric Surgery and Long-term Durability of Weight Loss.

Journal Article JAMA Surg · November 1, 2016 IMPORTANCE: Bariatric surgery induces significant weight loss for severely obese patients, but there is limited evidence of the durability of weight loss compared with nonsurgical matches and across bariatric procedures. OBJECTIVES: To examine 10-year weig ... Full text Link to item Cite

Few Disparities in Baseline Laboratory Testing After the Diuretic or Digoxin Initiation by Medicare Fee-For-Service Beneficiaries.

Journal Article Circ Cardiovasc Qual Outcomes · November 2016 BACKGROUND: Despite the persistence of significant disparities, few evaluations examine disparities in laboratory testing by race/ethnicity, age, sex, Medicaid eligibility, and number of chronic conditions for Medicare fee-for-service beneficiaries' newly ... Full text Link to item Cite

Appropriate baseline laboratory testing following ACEI or ARB initiation by Medicare FFS beneficiaries.

Journal Article Pharmacoepidemiol Drug Saf · September 2016 BACKGROUND: Laboratory testing to identify contraindications and adverse drug reactions is important for safety of patients initiating angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs). Rates and predictors of appropria ... Full text Link to item Cite

Understanding Treatment Effect Terminology in Pain and Symptom Management Research.

Journal Article J Pain Symptom Manage · September 2016 Within health services and medical research, there is a wide variety of terminology related to treatment effects. Understanding differences in types of treatment effects is especially important in pain and symptom management research where nonexperimental ... Full text Link to item Cite

Using Electronic Health Record Data to Measure Care Quality for Individuals with Multiple Chronic Medical Conditions.

Journal Article J Am Geriatr Soc · September 2016 OBJECTIVES: To inform the development of a data-driven measure of quality care for individuals with multiple chronic conditions (MCCs) derived from an electronic health record (EHR). DESIGN: Qualitative study using focus groups, interactive webinars, and a ... Full text Link to item Cite

Abstinence Reinforcement Therapy (ART) for rural veterans: Methodology for an mHealth smoking cessation intervention.

Journal Article Contemp Clin Trials · September 2016 INTRODUCTION: Smoking is the most preventable cause of morbidity and mortality in U.S. veterans. Rural veterans in particular have elevated risk for smoking and smoking-related illness. However, these veterans underutilize smoking cessation treatment, whic ... Full text Link to item Cite

Do Veterans Health Administration Enrollees Generalize to Other Populations?

Journal Article Med Care Res Rev · August 2016 The Veterans Health Administration (VHA) has historically served a disproportionately male patient population with lower income and greater rates of mental illness than non-VHA populations. The generalizability of research based on VHA enrollees is unknown ... Full text Link to item Cite

Frequency of Disparities in Laboratory Testing After Statin Initiation in Subjects ≥65 Years.

Journal Article Am J Cardiol · August 1, 2016 Laboratory testing is important for the safety of older adults initiating statins, but there has been little examination of laboratory testing disparities by race/ethnicity, age, gender, Medicaid eligibility, and multimorbidity. The study's purpose was to ... Full text Link to item Cite

The Economic Burden of Chronic Kidney Disease and End-Stage Renal Disease.

Journal Article Semin Nephrol · July 2016 The growing prevalence and progression of chronic kidney disease (CKD) raises concerns about our capacity to manage its economic burden to patients, caregivers, and society. The societal direct and indirect costs of CKD and end-stage renal disease are subs ... Full text Link to item Cite

Low-density lipoprotein cholesterol level and statin use among Medicare beneficiaries with diabetes mellitus.

Journal Article Diab Vasc Dis Res · May 2016 At the time of this study, guidelines recommended a primary goal of low-density lipoprotein cholesterol level less than 100 mg/dL for all patients, an optional goal of low-density lipoprotein cholesterol less than 70 mg/dL for patients with overt cardiovas ... Full text Link to item Cite

Primary care physician decision making regarding severe obesity treatment and bariatric surgery: a qualitative study.

Journal Article Surg Obes Relat Dis · May 2016 BACKGROUND: Less than 1% of severely obese US adults undergo bariatric surgery annually. It is critical to understand the factors that contribute to its utilization. OBJECTIVES: To understand how primary care physicians (PCPs) make decisions regarding seve ... Full text Open Access Link to item Cite

A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.

Journal Article J Gen Intern Med · March 2016 BACKGROUND: Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes. OBJECTIVE: Our objective was to develop a conceptual model of co ... Full text Open Access Link to item Cite

Implementation of a prediabetes identification algorithm for overweight and obese Veterans.

Journal Article J Rehabil Res Dev · 2016 Type 2 diabetes prevention is an important national goal for the Veteran Health Administration (VHA): one in four Veterans has diabetes. We implemented a prediabetes identification algorithm to estimate prediabetes prevalence among overweight and obese Vet ... Full text Link to item Cite

Does Type 2 Diabetes Genetic Testing and Counseling Reduce Modifiable Risk Factors? A Randomized Controlled Trial of Veterans.

Journal Article J Gen Intern Med · November 2015 OBJECTIVE: We examined the clinical utility of supplementing type 2 diabetes mellitus (DM) risk counseling with DM genetic test results and counseling. RESEARCH DESIGN AND METHODS: In this randomized controlled trial, non-diabetic overweight/obese veteran ... Full text Link to item Cite

Linkage of Laboratory Results to Medicare Fee-for-Service Claims.

Journal Article Med Care · November 2015 BACKGROUND: Medicare is the single largest purchaser of laboratory testing in the United States, yet test results associated with Medicare laboratory claims have historically not been available. OBJECTIVE: The purpose of this study was to describe both the ... Full text Link to item Cite

Control Outcomes and Exposures for Improving Internal Validity of Nonrandomized Studies.

Journal Article Health Serv Res · October 2015 OBJECTIVE: Control outcomes and exposures can improve internal validity of nonrandomized studies by assessing residual bias in effect estimates. Control outcomes are those expected to have no treatment effect or the opposite effect of the primary outcome. ... Full text Link to item Cite

Physician Non-adherence to Colonoscopy Interval Guidelines in the Veterans Affairs Healthcare System.

Journal Article Gastroenterology · October 2015 BACKGROUND & AIMS: Colonoscopy can decrease colorectal cancer (CRC) mortality, although performing this procedure more frequently than recommended could increase costs and risks to patients. We aimed to determine rates and correlates of physician non-adher ... Full text Link to item Cite

Implementation and evaluation of the VA DPP clinical demonstration: protocol for a multi-site non-randomized hybrid effectiveness-implementation type III trial.

Journal Article Implement Sci · May 12, 2015 BACKGROUND: The Diabetes Prevention Program (DPP) study showed that lifestyle intervention resulted in a 58% reduction in incidence of type 2 diabetes among individuals with prediabetes. Additional large randomized controlled trials have confirmed these re ... Full text Link to item Cite

Partial Meal Replacement Plan and Quality of the Diet at 1 Year: Action for Health in Diabetes (Look AHEAD) Trial.

Journal Article J Acad Nutr Diet · May 2015 BACKGROUND: Little is known about diet quality with a reduced-energy, low-fat, partial meal replacement plan, especially in individuals with type 2 diabetes. The Action for Health in Diabetes (Look AHEAD) trial implemented a partial meal replacement plan i ... Full text Link to item Cite

Comparing Survival Following Hip Fracture Repair in VHA and Non-VHA Facilities

Journal Article Geriatric Orthopaedic Surgery and Rehabilitation · March 13, 2015 Full text Cite

Prescriber continuity and medication adherence for complex patients.

Journal Article Ann Pharmacother · March 2015 BACKGROUND: Medication adherence is a critical aspect of managing cardiometabolic conditions, including diabetes, hypertension, dyslipidemia, and heart failure. Patients who have multiple cardiometabolic conditions and multiple prescribers may be at increa ... Full text Link to item Cite

Impact of automated reporting of estimated glomerular filtration rate in the veterans health administration.

Journal Article Med Care · February 2015 BACKGROUND: Early detection and treatment of chronic kidney disease (CKD) is important for slowing progression to renal failure and preventing cardiovascular events, but CKD is often not recognized and patients are referred to nephrologists too late for ti ... Full text Link to item Cite

Association between bariatric surgery and long-term survival.

Journal Article JAMA · January 6, 2015 IMPORTANCE: Accumulating evidence suggests that bariatric surgery improves survival among patients with severe obesity, but research among veterans has shown no evidence of benefit. OBJECTIVE: To examine long-term survival in a large multisite cohort of pa ... Full text Link to item Cite

Inertia in health care organizations: A case study of peritoneal dialysis services.

Journal Article Health Care Manage Rev · 2015 BACKGROUND: Change is difficult for health care organizations where adoption of new practices is notoriously slow. Inertial behavior may reflect organizations' rational, strategic nonresponse to its environment or latent, institutionalizing preservation of ... Full text Link to item Cite

Extent and reasons for nonadherence to antihypertensive, cholesterol, and diabetes medications: the association with depressive symptom burden in a sample of American veterans.

Journal Article Patient Prefer Adherence · 2015 OBJECTIVE: Persons with depressive symptoms generally have higher rates of medication nonadherence than persons without depressive symptoms. However, little is known about whether this association differs by comorbid medical condition or whether reasons fo ... Full text Link to item Cite

A marginalized two-part model for semicontinuous data.

Journal Article Stat Med · December 10, 2014 In health services research, it is common to encounter semicontinuous data characterized by a point mass at zero followed by a right-skewed continuous distribution with positive support. Examples include health expenditures, in which the zeros represent a ... Full text Link to item Cite

Approaches for informing optimal dose of behavioral interventions.

Journal Article Ann Behav Med · December 2014 BACKGROUND: There is little guidance about to how select dose parameter values when designing behavioral interventions. PURPOSE: The purpose of this study is to present approaches to inform intervention duration, frequency, and amount when (1) the investig ... Full text Link to item Cite

Predictors of treatment initiation with tumor necrosis factor-α inhibitors in patients with rheumatoid arthritis.

Journal Article J Manag Care Spec Pharm · November 2014 BACKGROUND: Introduction of biologic disease-modifying antirheumatic drugs (DMARDs) has revolutionized treatment in patients with rheumatoid arthritis (RA). However, due to substantially higher costs of biologics compared with nonbiologics, patients with l ... Full text Link to item Cite

Tumor necrosis factor-α inhibitor treatment and the risk of incident cardiovascular events in patients with early rheumatoid arthritis: a nested case-control study.

Journal Article J Rheumatol · November 2014 OBJECTIVE: To compare the risk of cardiovascular (CV) events between use of tumor necrosis factor-α inhibitors (TNFi) and nonbiologic disease-modifying antirheumatic drugs (DMARD) in patients with early rheumatoid arthritis (RA). METHODS: A nested case-con ... Full text Link to item Cite

Patient perspectives on having multiple versus single prescribers of chronic disease medications: results of a qualitative study in a veteran population.

Journal Article BMC Health Serv Res · October 25, 2014 BACKGROUND: Patients with multiple chronic conditions often have multiple prescribers, which has been associated with greater health care utilization and medication nonadherence in claims-based analyses. This qualitative study was conducted to understand t ... Full text Link to item Cite

Study design and protocol for a theory-based behavioral intervention focusing on maintenance of weight loss: the Maintenance After Initiation of Nutrition TrAINing (MAINTAIN) study.

Journal Article Contemp Clin Trials · September 2014 BACKGROUND: Obesity is a significant public health problem. Although various lifestyle approaches are effective for inducing significant weight loss, few effective behavioral weight maintenance strategies have been identified. It has been proposed that beh ... Full text Link to item Cite

Examining the relationship between adjunctive psychotherapy use and antipsychotic persistence and hospitalization.

Journal Article Adm Policy Ment Health · September 2014 This study assessed whether the addition of adjunctive psychotherapy to antipsychotic pharmacotherapy improved antipsychotic persistence and reduced the risk of hospitalization among patients with schizophrenia using 2001-2003 Medicaid claims data from fou ... Full text Link to item Cite

Does Favorable Selection Among Medicare Advantage Enrollees Affect Measurement of Hospital Readmission Rates?

Journal Article Med Care Res Rev · August 2014 Literature indicates favorable selection among Medicare Advantage (MA) enrollees compared with fee-for-service (FFS) enrollees. This study examined whether favorable selection into MA affected readmission rates among Medicare-eligible veterans following ho ... Full text Link to item Cite

Massachusetts health reform and Veterans Affairs health system enrollment.

Journal Article Am J Manag Care · August 2014 OBJECTIVES: Veterans Health Administration (VA) operates the largest integrated health system in the nation. The Affordable Care Act (ACA) does not require any changes to VA, but the individual mandate and expanded health insurance options may change veter ... Link to item Cite

Obesity-related health status changes and weight-loss treatment utilization.

Journal Article Am J Prev Med · May 2014 BACKGROUND: Behavioral weight-loss treatment can improve health, yet it is underutilized. Factors leading to initiation of weight-loss treatment are not well characterized. In particular, it is unknown whether changes in obesity-related health status contr ... Full text Link to item Cite

Value-based insurance design: the authors reply.

Journal Article Health Aff (Millwood) · May 2014 Full text Link to item Cite

The intersection of patient complexity, prescriber continuity and acute care utilization.

Journal Article J Gen Intern Med · April 2014 BACKGROUND: Care continuity is considered a critical characteristic of high-performing health systems. Few studies have examined the continuity of medication management of complex patients, who often have multiple providers and complex medication regimens. ... Full text Link to item Cite

Approaches to comparative effectiveness research in multimorbid populations.

Journal Article Med Care · March 2014 There is an urgent need for an evidence base to guide care for patients with multiple chronic medical conditions (MCC). Comparative effectiveness research (CER) has been touted as 1 solution to generating such evidence. However, the majority of CER topics ... Full text Link to item Cite

Costs associated with multimorbidity among VA patients.

Journal Article Med Care · March 2014 BACKGROUND: Multimorbidity (the presence of multiple chronic conditions) is associated with high levels of healthcare utilization and associated costs. We investigated the association between number of chronic conditions and costs of care for nonelderly an ... Full text Link to item Cite

Do the benefits of participation in a hypertension self-management trial persist after patients resume usual care?

Journal Article Circ Cardiovasc Qual Outcomes · March 2014 BACKGROUND: Hypertension self-management has been shown to improve systolic blood pressure (BP) control, but longer-term economic and clinical impacts are unknown. The purpose of this article is to examine clinical and economic outcomes 18 months after com ... Full text Open Access Link to item Cite

Value-based insurance design program in north Carolina increased medication adherence but was not cost neutral.

Journal Article Health Aff (Millwood) · February 2014 Value-based insurance design (VBID) has shown promise for improving medication adherence by lowering or eliminating patients' payments for some medications. Yet the business case for VBID remains unclear. VBID is based on the premise that higher medication ... Full text Link to item Cite

Trends in energy and macronutrient intakes by weight status over four decades.

Journal Article Public Health Nutr · February 2014 OBJECTIVE: To examine whether the recent increasing prevalence of obesity was accompanied by variations in energy and macronutrient intakes by weight status. DESIGN: Time series of cross-sectional surveys. SETTING: National Health and Nutrition Examination ... Full text Link to item Cite

Characterizing weekly self-reported antihypertensive medication nonadherence across repeated occasions.

Journal Article Patient Prefer Adherence · 2014 BACKGROUND: Little is known about weekly variability in medication nonadherence both between and within persons. PURPOSE: To characterize medication nonadherence across repeated, closely spaced occasions. METHODS: This prospective cohort study comprised fo ... Full text Link to item Cite

Continuity of medication management and continuity of care: Conceptual and operational considerations.

Journal Article SAGE Open Med · 2014 OBJECTIVE: Continuity of care is considered foundational to high-quality care. Traditional continuity of care constructs may adequately characterize care quality in general populations, but may merit reconceptualization for patients with multiple chronic c ... Full text Link to item Cite

Recognition of CKD after the introduction of automated reporting of estimated GFR in the Veterans Health Administration.

Journal Article Clin J Am Soc Nephrol · January 2014 BACKGROUND AND OBJECTIVES: Early detection of CKD is important for slowing progression to renal failure and preventing cardiovascular events. Automated laboratory reporting of estimated GFR (eGFR) has been introduced in many health systems to improve CKD r ... Full text Link to item Cite

MOVE: weight management program across the Veterans Health Administration: patient- and facility-level predictors of utilization.

Journal Article BMC Health Serv Res · December 10, 2013 BACKGROUND: Health care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE!® ... Full text Link to item Cite

Nonadherence to medications.

Journal Article JAMA · October 9, 2013 Full text Link to item Cite

Beta-binomial regression and bimodal utilization.

Journal Article Health Serv Res · October 2013 OBJECTIVE: To illustrate how the analysis of bimodal U-shaped distributed utilization can be modeled with beta-binomial regression, which is rarely used in health services research. DATA SOURCES/STUDY SETTING: Veterans Affairs (VA) administrative data and ... Full text Link to item Cite

The continuity and quality of primary care.

Journal Article Med Care Res Rev · October 2013 Patients who have access to different health care systems, such as Medicare-eligible veterans, may obtain services in either or both health systems. We examined whether quality of diabetes care was associated with care continuity or veterans' usual source ... Full text Link to item Cite

Cost-effectiveness of bariatric surgery.

Journal Article JAMA · August 21, 2013 JAMA SURGERY: Impact of Bariatric Surgery on Health Care Costs of Obese Persons: A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data Jonathan P. Weiner, DrPH; Suzanne M. Goodwin, PhD; Hsien-Yen Chang, PhD, MHS; Shari D. Bolen, MD, ... Full text Link to item Cite

Potential bias in medication adherence studies of prevalent users.

Journal Article Health Serv Res · August 2013 PURPOSE: We examined how the choice of historic medication use criteria for identifying prevalent users may bias estimated adherence changes associated with a medication copayment increase. METHODS: From pharmacy claims data in a retrospective cohort study ... Full text Link to item Cite

Does the association between prescription copayment increases and medication adherence differ by race?

Journal Article J Health Care Poor Underserved · August 2013 Previous studies have shown prescription copayment increases are associated with decreases in adherence to diabetes and hypertension medications, but have not investigated whether these associations differ by race. Veterans Affairs (VA) administrative data ... Full text Link to item Cite

Real-world utilization patterns and outcomes of colesevelam hcl in the ge electronic medical record.

Journal Article BMC Endocr Disord · July 17, 2013 BACKGROUND: In randomized controlled trials (RCTs), colesevelam HCI, added to other anti-diabetic therapy, reduced hemoglobin A1C by approximately 0.3% to 0.4% over 16- to 26-weeks compared with an increase of approximately 0.1% to 0.2% for placebo, for a ... Full text Link to item Cite

The Cholesterol, Hypertension, And Glucose Education (CHANGE) study: results from a randomized controlled trial in African Americans with diabetes.

Journal Article Am Heart J · July 2013 BACKGROUND: Cardiovascular disease (CVD) and diabetes account for one-third of the mortality difference between African American and white patients. We evaluated the effect of a CVD risk reduction intervention in African Americans with diabetes. METHODS: W ... Full text Open Access Link to item Cite

Value-based insurance design: quality improvement but no cost savings.

Journal Article Health Aff (Millwood) · July 2013 Value-based insurance design (VBID) is an approach that attempts to improve the quality of care by selectively encouraging or discouraging the use of specific health care services, based on their potential benefit to patients' health, relative to their cos ... Full text Link to item Cite

Demand for weight loss counseling after copayment elimination.

Journal Article Preventing chronic disease · June 17, 2013 Overweight and obesity are public health issues in the United States, and veterans have a higher rate of overweight and obesity than the general population. Our objective was to examine whether copayment elimination increased use of a weight loss clinic by ... Cite

Time until incident dementia among Medicare beneficiaries using centrally acting or non-centrally acting ACE inhibitors.

Journal Article Pharmacoepidemiol Drug Saf · June 2013 BACKGROUND: Centrally active (CA) angiotensin-converting enzyme inhibitors (ACEIs) are able to cross the blood–brain barrier. Small observational studies and mouse models suggest that use of CA versus non-CA ACEIs is associated with a reduced incidence of ... Full text Link to item Cite

In response.

Journal Article Med Care · May 2013 Full text Link to item Cite

Wide clinic-level variation in adherence to oral diabetes medications in the VA.

Journal Article J Gen Intern Med · May 2013 BACKGROUND: While there has been extensive research into patient-specific predictors of medication adherence and patient-specific interventions to improve adherence, there has been little examination of variation in clinic-level medication adherence. OBJEC ... Full text Link to item Cite

Demand for weight loss counseling after copayment elimination.

Journal Article Prev Chronic Dis · April 4, 2013 INTRODUCTION: Overweight and obesity are public health issues in the United States, and veterans have a higher rate of overweight and obesity than the general population. Our objective was to examine whether copayment elimination increased use of a weight ... Full text Link to item Cite

Study design elements for rigorous quasi-experimental comparative effectiveness research.

Journal Article J Comp Eff Res · March 2013 Quasi-experiments are likely to be the workhorse study design used to generate evidence about the comparative effectiveness of alternative treatments, because of their feasibility, timeliness, affordability and external validity compared with randomized tr ... Full text Link to item Cite

Racial differences among patients undergoing laparoscopic gastric bypass surgery: a population-based trend analysis from 2002 to 2008.

Journal Article Obes Surg · February 2013 BACKGROUND: Laparoscopic gastric bypass surgery (LGBS) has become the most widely used bariatric procedure due to its beneficial long-term outcomes for patients with morbid obesity. However, it is unclear whether racial differences in admission for LGBS ha ... Full text Link to item Cite

Improving hip fractures outcomes for COPD patients.

Journal Article COPD · February 2013 UNLABELLED: Hip fractures in the elderly have high rates of mortality and perioperative complications. Both men and COPD patients have worse mortality and complications but this may be due to more co-morbid disease. We assessed mortality and complications ... Full text Link to item Cite

Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providers.

Journal Article BMC Health Serv Res · January 18, 2013 BACKGROUND: Demand for dialysis treatment exceeds its supply within the Veterans Health Administration (VA), requiring VA to outsource dialysis care by purchasing private sector dialysis for veterans on a fee-for-service basis. It is unclear whether outcom ... Full text Link to item Cite

The impact of manufacturer coupon use in the statin market.

Journal Article J Manag Care Pharm · 2013 BACKGROUND: Pharmaceutical manufacturer coupons are a rapidly growing promotional activity intended to encourage initiation and continuing use of brand-name medications, but little is known about impacts on medication adherence and expenditures. OBJECTIVE: ... Full text Link to item Cite

Determinants of postsurgical discharge setting for male hip fracture patients.

Journal Article J Rehabil Res Dev · 2013 Veterans hospitalized for hip fracture repair may be discharged to one of several rehabilitation settings, but it is not known what factors influence postsurgical discharge setting. The purpose of the study was to examine the patient, facility, and market ... Full text Link to item Cite

Predictors of initial weight loss after gastric bypass surgery in twelve Veterans Affairs Medical Centers.

Journal Article Obes Res Clin Pract · 2013 The objective of this study was to identify determinants of significant weight loss one year after gastric bypass surgery among United States veterans. Using data from the Veterans Affairs (VA) Surgical Quality Improvement Program, we identified 516 vetera ... Full text Link to item Cite

Demand for weight loss counseling after copayment elimination.

Journal Article Preventing chronic disease · 2013 Overweight and obesity are public health issues in the United States, and veterans have a higher rate of overweight and obesity than the general population. Our objective was to examine whether copayment elimination increased use of a weight loss clinic by ... Full text Cite

Initial validation of a self-report measure of the extent of and reasons for medication nonadherence.

Journal Article Med Care · December 2012 Featured Publication BACKGROUND: Self-report measures of medication nonadherence confound the extent of and reasons for medication nonadherence. Each construct is assessed with a different type of psychometric model, which dictates how to establish reliability and validity. OB ... Full text Link to item Cite

Does the presence of a pharmacist in primary care clinics improve diabetes medication adherence?

Journal Article BMC Health Serv Res · November 13, 2012 BACKGROUND: Although oral hypoglycemic agents (OHAs) are an essential element of therapy for the management of type 2 diabetes, OHA adherence is often suboptimal. Pharmacists are increasingly being integrated into primary care as part of the move towards a ... Full text Link to item Cite

Informing the dosing of interventions in randomized trials.

Journal Article Contemp Clin Trials · November 2012 Featured Publication Dosing is potentially the most important decision that must be made when building or refining behavioral interventions. In this paper, we propose standardized terminology and reporting of dosing information, which would inform intervention development, ref ... Full text Link to item Cite

Adherence to antipsychotics and cardiometabolic medication: association with health care utilization and costs.

Journal Article Psychiatr Serv · September 1, 2012 Featured Publication OBJECTIVE: This study examined the association between adherence to antipsychotic and cardiometabolic medication and annual use of health care services and expenditures. METHODS: MarketScan Medicaid files from 2004 to 2008 were used to evaluate annual cros ... Full text Link to item Cite

How price responsive is the demand for specialty care?

Journal Article Health Econ · August 2012 Featured Publication OBJECTIVES: Outpatient visit co-payments have increased in recent years. We estimate the patient response to a price change for specialty care, based on a co-payment increase from $15 to $50 per visit for veterans with hypertension. DESIGN, SETTING, AND PA ... Full text Link to item Cite

Examining the impact of genetic testing for type 2 diabetes on health behaviors: study protocol for a randomized controlled trial.

Journal Article Trials · August 1, 2012 Featured Publication BACKGROUND: We describe the study design, procedures, and development of the risk counseling protocol used in a randomized controlled trial to evaluate the impact of genetic testing for diabetes mellitus (DM) on psychological, health behavior, and clinical ... Full text Link to item Cite

Implementation of automated reporting of estimated glomerular filtration rate among Veterans Affairs laboratories: a retrospective study.

Journal Article BMC Med Inform Decis Mak · July 12, 2012 Featured Publication BACKGROUND: Automated reporting of estimated glomerular filtration rate (eGFR) is a recent advance in laboratory information technology (IT) that generates a measure of kidney function with chemistry laboratory results to aid early detection of chronic kid ... Full text Open Access Link to item Cite

Health expenditures among high-risk patients after gastric bypass and matched controls.

Journal Article Arch Surg · July 2012 Featured Publication OBJECTIVE: To determine whether bariatric surgery is associated with reduced health care expenditures in a multisite cohort of predominantly older male patients with a substantial disease burden. DESIGN: Retrospective cohort study of bariatric surgery. Out ... Full text Link to item Cite

Measures of adherence to oral hypoglycemic agents at the primary care clinic level: the role of risk adjustment.

Journal Article Med Care · July 2012 Featured Publication BACKGROUND: Prior research found that in the Veterans Affairs health care system (VA), the proportion of patients adherent to oral hypoglycemic agents varies from 50% to 80% across primary care clinics. This study examined whether variation in patient and ... Full text Link to item Cite

Medication adherence changes following value-based insurance design.

Journal Article Am J Manag Care · May 2012 Featured Publication OBJECTIVES: To determine whether participation in a value-based insurance design (VBID) program was associated with improved medication adherence in 8 drug classes 2 years after implementation and to examine whether adherence changes varied by baseline adh ... Link to item Cite

Use of outpatient care in VA and Medicare among disability-eligible and age-eligible veteran patients.

Journal Article BMC Health Serv Res · March 5, 2012 Featured Publication BACKGROUND: More than half of veterans who use Veterans Health Administration (VA) care are also eligible for Medicare via disability or age, but no prior studies have examined variation in use of outpatient services by Medicare-eligible veterans across he ... Full text Link to item Cite

State disparities in time trends of adolescent body mass index percentile and weight-related behaviors in the United States.

Journal Article J Community Health · February 2012 Featured Publication Evidence is conflicting as to whether youth obesity prevalence has reached a plateau in the United States overall. Trends vary by state, and experts recommend exploring whether trends in weight-related behaviors are associated with changes in weight status ... Full text Link to item Cite

Medicare part D information seeking: the role of recognition of need and patient activation.

Journal Article Res Social Adm Pharm · 2012 Featured Publication BACKGROUND: In 2006, Medicare beneficiaries had the opportunity to choose from multiple newly available Medicare prescription drug plans (PDPs). Many beneficiaries reported difficulty in finding helpful information, whereas others reported they never looke ... Full text Link to item Cite

Risk stratification of serious adverse events after gastric bypass in the Bariatric Outcomes Longitudinal Database.

Journal Article Surg Obes Relat Dis · 2012 BACKGROUND: There is now sufficient demand for bariatric surgery to compare bariatric surgeons and bariatric centers according to their postsurgical outcomes, but few validated risk stratification measures are available to enable valid comparisons. The pur ... Full text Link to item Cite

Antipsychotic adherence and its correlation to health outcomes for chronic comorbid conditions.

Journal Article Prim Care Companion CNS Disord · 2012 OBJECTIVE: To examine the relationship between adherence to antipsychotics and adherence to medications for cardiometabolic conditions (diabetes, hypertension, and hyperlipidemia) and subsequent health care utilization and expenditures in patients with sch ... Full text Link to item Cite

Does medication adherence following a copayment increase differ by disease burden?

Journal Article Health Serv Res · December 2011 Featured Publication OBJECTIVES: To compare changes in medication adherence between patients with high- or low-comorbidity burden after a copayment increase. METHODS: We conducted a retrospective observational study at four Veterans Affairs (VA) medical centers by comparing ve ... Full text Link to item Cite

Early evidence on the quality of care provided by special needs plans.

Journal Article Med Care · October 2011 Featured Publication BACKGROUND: Medicare Advantage special needs plans (SNPs) have grown significantly over the past 7 years, but patient outcomes have only recently been publicly reported. METHODS: Reporting rates and scores on 4 publicly reported Healthcare Effectiveness Da ... Full text Link to item Cite

Reliance on Veterans Affairs outpatient care by Medicare-eligible veterans.

Journal Article Med Care · October 2011 Featured Publication OBJECTIVE: To examine longitudinal changes in Medicare-eligible veterans' reliance on the Department of Veterans Affairs (VA) healthcare system for primary and specialty care over 4 years. METHODS: We merged VA administrative and Medicare claims data to ex ... Full text Link to item Cite

Longitudinal analysis of market factors associated with provision of peritoneal dialysis services.

Journal Article Med Care Res Rev · October 2011 Featured Publication Despite the appeal of peritoneal dialysis (PD) among patients, payers, and providers, its use in the United States has been limited and declining. Prior research has found that patient factors explain little variation in PD utilization, and little is known ... Full text Link to item Cite

State policies targeting junk food in schools: racial/ethnic differences in the effect of policy change on soda consumption.

Journal Article Am J Public Health · September 2011 Featured Publication OBJECTIVES: We estimated the association between state policy changes and adolescent soda consumption and body mass index (BMI) percentile, overall and by race/ethnicity. METHODS: We obtained data on whether states required or recommended that schools proh ... Full text Link to item Cite

A budget impact analysis of telemedicine-based collaborative care for depression.

Journal Article Med Care · September 2011 Featured Publication BACKGROUND: Patients with depression use more health services than patients without depression. However, when depression symptoms respond to treatment, use of health services declines. Most depression quality improvement studies increase total cost in the ... Full text Link to item Cite

Strict hand hygiene and other practices shortened stays and cut costs and mortality in a pediatric intensive care unit.

Journal Article Health Aff (Millwood) · September 2011 Featured Publication Efforts to reduce infections acquired during a hospital stay through improvements in the quality of care have had measurable results in many hospital settings. In pediatric intensive care units, the right quality interventions can save lives and money. We ... Full text Link to item Cite

Nurse staffing and patient care costs in acute inpatient nursing units.

Journal Article Med Care · August 2011 Featured Publication OBJECTIVE: Studies suggest that a business case for improving nurse staffing can be made to increase registered nurse (RN) skill mix without changing total licensed nursing hours. It is unclear whether a business case for increasing RN skill mix can be jus ... Full text Link to item Cite

Continuity of antipsychotic medication management for Medicaid patients with schizophrenia.

Journal Article Psychiatr Serv · July 2011 Featured Publication OBJECTIVE: The purpose of this study was to examine whether medication refill behavior varies by the number of prescribers of antipsychotic medication a patient has. METHODS: A total of 7,868 patients with schizophrenia were identified from North Carolina ... Full text Link to item Cite

Survival among high-risk patients after bariatric surgery.

Journal Article JAMA · June 15, 2011 Featured Publication CONTEXT: Existing evidence of the survival associated with bariatric surgery is based on cohort studies of predominantly younger women with a low inherent obesity-related mortality risk. The association of survival and bariatric surgery for older men is le ... Full text Link to item Cite

Health plan enrollment and mortality in the Medicare program.

Journal Article Health Econ · June 2011 Featured Publication Prior studies have found that Medicare health maintenance organization (HMO) enrollees have lower mortality (over a fixed observation period) than beneficiaries in traditional fee-for-service (FFS) Medicare. We use Medicare Current Beneficiary Survey (MCBS ... Full text Link to item Cite

RELIANCE ON VA OUTPATIENT SERVICES BY MEDICARE-ELIGIBLE VETERANS

Journal Article JOURNAL OF GENERAL INTERNAL MEDICINE · May 1, 2011 Link to item Cite

Repeat experience with the doughnut hole in Medicare Part D: when the doughnut hole becomes a tunnel.

Journal Article Med Care · May 2011 Featured Publication OBJECTIVE: To describe the proportion of elderly Medicare advantage prescription drug plan (MAPDP) enrollees who meet or exceed the Medicare Part D doughnut hole (DH) entry threshold in 2 consecutive years and which characteristics put them at risk for rep ... Full text Link to item Cite

Cost-related nonadherence in the Medicare program: the impact of Part D.

Journal Article Med Care · May 2011 Featured Publication BACKGROUND: Cost-related nonadherence (CRN) among Medicare beneficiaries declined after the implementation of the Part D program, but it is unknown whether CRN changes varied on the basis of beneficiaries' change in drug coverage. OBJECTIVE: To determine h ... Full text Link to item Cite

Synonyms in health services research methodology.

Journal Article Med Care Res Rev · April 2011 Featured Publication There are often multiple discipline-specific terms for a given statistical concept, which can sow confusion in multidisciplinary teams or study sections if researchers are not aware of the synonyms from other disciplines. This article incorporates synonyms ... Full text Link to item Cite

Improving the measurement of self-reported medication nonadherence.

Journal Article J Clin Epidemiol · March 2011 Featured Publication OBJECTIVE: Medication nonadherence is a significant clinical problem in chronic disease management. Self-report measures have inadequate reliability and poor distributional properties. We demonstrate how two fundamental measurement issues have limited the ... Full text Link to item Cite

Improving the measurement of self-reported medication nonadherence: Response to authors

Journal Article Journal of Clinical Epidemiology · March 1, 2011 Full text Cite

Importance of health system context for evaluating utilization patterns across systems.

Journal Article Health Econ · February 2011 Featured Publication Measuring health services provided to patients can be difficult when patients see providers across multiple health systems and all visits are rarely captured in a single data source covering all systems where patients receive care. Studies that account for ... Full text Link to item Cite

Health-care expenditures of overweight and obese males and females in the medical expenditures panel survey by age cohort.

Journal Article Obesity (Silver Spring) · January 2011 Featured Publication Age- and sex-specific annual health-care expenditures (total, in-patient, ambulatory care, and outpatient prescription drug) were estimated within established weight classifications in a nationally representative sample of children and adults aged 6-85 yea ... Full text Link to item Cite

Are smoking and alcohol misuse associated with subsequent hospitalizations for ambulatory care sensitive conditions?

Journal Article J Behav Health Serv Res · January 2011 Featured Publication Hospitalizations for ambulatory care sensitive conditions (ACSCs) are used to assess quality of care, but studies rarely adjust for health behaviors. This study evaluated whether results of smoking or alcohol screening were associated with hospitalizations ... Full text Link to item Cite

Relationship of pharmaceutical promotion to antidepressant switching and adherence: a retrospective cohort study.

Journal Article Psychiatr Serv · December 2010 Featured Publication OBJECTIVE: Patient nonadherence and early discontinuation of antidepressant treatment are common. Pharmaceutical promotion to consumers and physicians may influence this behavior. The objectives of this study were to explore whether promotional spending is ... Full text Link to item Cite

Health care utilization and expenditure changes associated with bariatric surgery.

Journal Article Med Care · November 2010 Featured Publication CONTEXT: Bariatric surgery provides significant reductions in weight and comorbidity, and has the potential to reduce health care utilization. It is unknown whether health care utilization and expenditures are reduced for veterans after bariatric surgery. ... Full text Link to item Cite

Copayment reductions generate greater medication adherence in targeted patients.

Journal Article Health Aff (Millwood) · November 2010 Featured Publication A large value-based insurance design program offered by Blue Cross Blue Shield of North Carolina eliminated generic medication copayments and reduced copayments for brand-name medications. Our study showed that the program improved adherence to medications ... Full text Link to item Cite

Use of outpatient care in Veterans Health Administration and Medicare among veterans receiving primary care in community-based and hospital outpatient clinics.

Journal Article Health Serv Res · October 2010 Featured Publication OBJECTIVE: To examine differences in use of Veterans Health Administration (VA) and Medicare outpatient services by VA primary care patients. DATA SOURCES/STUDY SETTING: VA administrative and Medicare claims data from 2001 to 2004. STUDY DESIGN: Retrospect ... Full text Link to item Cite

US hospitalizations and costs for illicit drug users with soft tissue infections.

Journal Article J Behav Health Serv Res · October 2010 Featured Publication Skin and soft tissue infections (SSTIs) are common complications of illicit drug use. Studies at single, urban hospitals demonstrate high rates of emergency department visits and hospitalizations for these infections. This study sought to estimate nationwi ... Full text Link to item Cite

Animal, vegetable, or ... clinical trial?

Journal Article Ann Intern Med · September 7, 2010 Featured Publication Full text Link to item Cite

Cost-effectiveness analysis of a rural telemedicine collaborative care intervention for depression.

Journal Article Arch Gen Psychiatry · August 2010 Featured Publication CONTEXT: Collaborative care interventions for depression in primary care settings are clinically beneficial and cost-effective. Most prior studies were conducted in urban settings. OBJECTIVE: To examine the cost-effectiveness of a rural telemedicine-based ... Full text Link to item Cite

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).

Journal Article Implement Sci · July 16, 2010 Featured Publication BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implemen ... Full text Open Access Link to item Cite

An examination of Alzheimer's disease case definitions using Medicare claims and survey data.

Journal Article Alzheimers Dement · July 2010 Featured Publication BACKGROUND: The prevalence and expenditure estimates of Alzheimer's disease (AD) from studies using one data source to define cases vary widely. The objectives of this study were to assess agreement between AD case definitions classified with Medicare clai ... Full text Link to item Cite

A retrospective cohort study of economic outcomes and adherence to monotherapy with metformin, pioglitazone, or a sulfonylurea among patients with type 2 diabetes mellitus in the United States from 2003 to 2005.

Journal Article Clin Ther · July 2010 Featured Publication OBJECTIVES: The aims of this study were to compare all-cause total health care costs and diabetes mellitus (DM)-specific health care costs between patients who were adherent or nonadherent to monotherapy with metformin, pioglitazone, or a sulfonylurea and ... Full text Link to item Cite

Risk adjustment for Medicare beneficiaries with Alzheimer's disease and related dementias.

Journal Article Am J Manag Care · March 2010 Featured Publication OBJECTIVE: To compare prospective risk adjustment measures on their ability to predict expenditures for Medicare beneficiaries with Alzheimer's disease and related dementias (ADRD). METHODS: Data were obtained from the 1999-2004 Medicare Current Beneficiar ... Link to item Cite

Part D plan enrollment by uninsured medicare beneficiaries.

Journal Article Med Care · February 2010 Featured Publication OBJECTIVES: The objective of the study was to examine the patient factors and medication acquisition strategies that impacted PDP enrollment in early 2006 by Medicare beneficiaries without prior drug coverage. RESEARCH DESIGN AND SUBJECTS: A retrospective ... Full text Link to item Cite

Increasing copayments and adherence to diabetes, hypertension, and hyperlipidemic medications.

Journal Article Am J Manag Care · January 1, 2010 Featured Publication OBJECTIVE: To examine the impact of a medication copayment increase on adherence to diabetes, hypertension, and hyperlipidemic medications. STUDY DESIGN: Retrospective pre-post observational study. METHODS: This study compared medication adherence at 4 Vet ... Link to item Cite

Testing social cognitive mechanisms of exercise in college students.

Journal Article Am J Health Behav · 2010 Featured Publication OBJECTIVES: To determine if different dimensions of outcome expectations are mediators between self-efficacy and exercise among college students. METHODS: Students (n = 290) reported exercise levels, self-efficacy, and expectations using a Web-based questi ... Full text Link to item Cite

Follow-up visits by provider specialty for patients with major depressive disorder initiating antidepressant treatment.

Journal Article Psychiatr Serv · January 2010 Featured Publication OBJECTIVES: This study examined the association between provider specialty and guideline-concordant care after the initiation of antidepressant treatment. METHODS: Medical and prescription claims were analyzed from adults newly diagnosed as having major de ... Full text Link to item Cite

Guideline-concordant antidepressant use among patients with major depressive disorder.

Journal Article Gen Hosp Psychiatry · 2010 Featured Publication OBJECTIVES: To examine whether prescriber specialty and guideline-concordant follow-up visits were associated with antidepressant treatment completion among patients with major depressive disorder (MDD). METHODS: This study analyzed medical and prescriptio ... Full text Link to item Cite

Discontinuation of diabetes and lipid-lowering medications after bariatric surgery at Veterans Affairs medical centers.

Journal Article Surg Obes Relat Dis · 2010 Featured Publication BACKGROUND: Bariatric surgery has largely been performed on middle-age female populations and been associated with significant medication discontinuation; however, it is unknown whether similar medication discontinuation rates could be achieved in men. The ... Full text Link to item Cite

Community-based aquatic exercise and quality of life in persons with osteoarthritis.

Journal Article Med Sci Sports Exerc · January 2010 Featured Publication PURPOSE: To evaluate the effectiveness of a community-based aquatic exercise program for improved quality of life among persons with osteoarthritis. METHOD: Two hundred forty-nine adults with osteoarthritis were enrolled in a 20-wk randomized controlled tr ... Full text Link to item Cite

The concentration and persistence of health care expenditures and prescription drug expenditures in Medicare beneficiaries with Alzheimer disease and related dementias.

Journal Article Med Care · November 2009 Featured Publication BACKGROUND: Alzheimer disease and related dementias (ADRD) have become a major concern for Medicare because of the increasing prevalence rate and the associated high cost of care. OBJECTIVES: This study investigated the extent of concentration and persiste ... Full text Link to item Cite

Medicare managed care enrollment by disability-eligible and age-eligible veterans.

Journal Article Med Care · November 2009 Featured Publication OBJECTIVE: To assess factors associated with enrollment in a Medicare advantage (MA) plan versus Medicare fee-for-service plan in 2000-2004 by Medicare-eligible veterans. We also assessed whether these factors differed between disability-eligible veterans ... Full text Link to item Cite

Equivalence of two healthcare costing methods: bottom-up and top-down.

Journal Article Health Econ · October 2009 Featured Publication This paper compares two quite different approaches to estimating costs: a 'bottom-up' approach, represented by the US Department of Veterans Affairs' (VA) Decision Support System that uses local costs of specific inputs; and a 'top-down' approach, represen ... Full text Link to item Cite

Predictors of long-term mortality after bariatric surgery performed in Veterans Affairs medical centers.

Journal Article Arch Surg · October 2009 Featured Publication HYPOTHESIS: The purpose of this study was to examine patient factors associated with mortality among veterans who undergo bariatric surgery. DESIGN: Prospective study that uses data from the Veterans Affairs (VA) National Surgical Quality Improvement Progr ... Full text Link to item Cite

The Cholesterol, Hypertension, and Glucose Education (CHANGE) study for African Americans with diabetes: study design and methodology.

Journal Article Am Heart J · September 2009 Featured Publication BACKGROUND: Cardiovascular disease (CVD) and diabetes account for over one third of the mortality difference between African Americans and white patients. The increased CVD risk in African Americans is due in large part to the clustering of multiple CVD ri ... Full text Link to item Cite

Adult asthma disease management: an analysis of studies, approaches, outcomes, and methods.

Journal Article Respir Care · July 2009 Featured Publication BACKGROUND: Disease management has been implemented for patients with asthma in various ways. We describe the approaches to and components of adult asthma disease-management interventions, examine the outcomes evaluated, and assess the quality of published ... Full text Link to item Cite

Suboptimal nutritional intake for hypertension control in 4 ethnic groups.

Journal Article Arch Intern Med · April 13, 2009 Featured Publication BACKGROUND: This study compared intake of specific nutrients based on the Dietary Approaches to Stop Hypertension (DASH) guidelines for hypertension management among multiethnic middle-aged and older adults. METHODS: We conducted quantitative analysis usin ... Full text Link to item Cite

Medication acquisition and self-reported adherence in veterans with hypertension.

Journal Article Med Care · April 2009 Featured Publication OBJECTIVES: To examine factors associated with oversupply and undersupply of antihypertensive medication, and examine evidence for medication acquisition as distinct from self-reported adherence. RESEARCH DESIGN: Analysis of pharmacy refill records, medica ... Full text Link to item Cite

Effects of two weight-loss diets on health-related quality of life.

Journal Article Qual Life Res · April 2009 Featured Publication PURPOSE: To compare the effects of two diets on health-related quality of life (HRQOL). METHODS: Overweight volunteers (n = 119) were randomized to follow a low-carbohydrate, ketogenic diet (LCKD) or a low-fat diet (LFD) for 24 weeks. HRQOL was measured ev ... Full text Link to item Cite

FACILITY LEVEL VARIATION IN ADHERENCE TO ORAL DIABETES MEDICATIONS

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · April 1, 2009 Link to item Cite

Health care costs in the last week of life: associations with end-of-life conversations.

Journal Article Arch Intern Med · March 9, 2009 Featured Publication BACKGROUND: Life-sustaining medical care of patients with advanced cancer at the end of life (EOL) is costly. Patient-physician discussions about EOL wishes are associated with lower rates of intensive interventions. METHODS: Funded by the National Institu ... Full text Link to item Cite

Performance of comorbidity, risk adjustment, and functional status measures in expenditure prediction for patients with diabetes.

Journal Article Diabetes Care · January 2009 Featured Publication OBJECTIVE: To compare the ability of generic comorbidity and risk adjustment measures, a diabetes-specific measure, and a self-reported functional status measure to explain variation in health care expenditures for individuals with diabetes. RESEARCH DESIG ... Full text Link to item Cite

Challenges in merging Medicaid and Medicare databases to obtain healthcare costs for dual-eligible beneficiaries: using diabetes as an example.

Journal Article Pharmacoeconomics · 2009 Featured Publication Dual-eligible Medicaid-Medicare beneficiaries represent a group of people who are in the lowest income bracket in the US, have numerous co-morbidities and place a heavy financial burden on the US healthcare system. As cost-effectiveness analyses are used t ... Full text Link to item Cite

Line authority for nurse staffing and costs for acute inpatient care.

Journal Article Inquiry · 2009 Featured Publication There is little empirical evidence evaluating the effects of recent, widespread changes in nurse executive roles and nursing management structures on the costs of patient care. This retrospective cross-sectional study examined the relationship between line ... Full text Link to item Cite

Healthcare cost differences with participation in a community-based group physical activity benefit for medicare managed care health plan members.

Journal Article J Am Geriatr Soc · August 2008 Featured Publication OBJECTIVES: To determine whether participation in a physical activity benefit by Medicare managed care enrollees is associated with lower healthcare utilization and costs. DESIGN: Retrospective cohort study. SETTING: Medicare managed care. PARTICIPANTS: A ... Full text Link to item Cite

Health care use and costs associated with use of a health club membership benefit in older adults with diabetes.

Journal Article Diabetes Care · August 2008 Featured Publication OBJECTIVE: The purpose of this study was to determine whether elective use of a health plan-sponsored health club membership had an impact on health care use and costs among older adults with diabetes. RESEARCH DESIGN AND METHODS: Administrative claims for ... Full text Link to item Cite

The impact of contract primary care on health care expenditures and quality of care.

Journal Article Med Care Res Rev · June 2008 Featured Publication The Department of Veterans Affairs (VA) established community-based outpatient clinics to improve veterans' access to primary care. This article compares VA use and expenditures among primary care users at 76 VA-staffed community clinics (n = 17,060) and 3 ... Full text Link to item Cite

Combined medication adherence to cardiovascular risk reduction therapy

Conference JOURNAL OF GENERAL INTERNAL MEDICINE · March 1, 2008 Link to item Cite

Managed-medicare health club benefit and reduced health care costs among older adults

Journal Article Preventing Chronic Disease · January 1, 2008 Introduction: Our study was undertaken to determine the association between use of a health plan-sponsored health club benefit by older adults and total health care costs over 2 years. Methods: This retrospective cohort study used administrative and claims ... Cite

Managed-Medicare health club benefit and reduced health care costs among older adults.

Journal Article Prev Chronic Dis · January 2008 Featured Publication INTRODUCTION: Our study was undertaken to determine the association between use of a health plan-sponsored health club benefit by older adults and total health care costs over 2 years. METHODS: This retrospective cohort study used administrative and claims ... Link to item Cite

Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study.

Journal Article BMC Health Serv Res · April 18, 2007 Featured Publication BACKGROUND: To compare VA inpatient and outpatient utilization and expenditures of veterans seeking primary care in community-based outpatient clinics (CBOCs) and VA medical centers (VAMCs) in fiscal years 2000 (FY00) and 2001. METHODS: The sample included ... Full text Link to item Cite

Impact of a managed-Medicare physical activity benefit on health care utilization and costs in older adults with diabetes.

Journal Article Diabetes Care · January 2007 Featured Publication OBJECTIVE: The purpose of this article was to determine the effects of a managed-Medicare physical activity benefit on health care utilization and costs among older adults with diabetes. RESEARCH DESIGN AND METHODS: This retrospective cohort study used adm ... Full text Link to item Cite

Baseline characteristics of the randomised cohort from the Look AHEAD (Action for Health in Diabetes) study

Journal Article Diabetes and Vascular Disease Research · December 1, 2006 Objective. The Look AHEAD (Action for Health in Diabetes) study is a 16-centre randomised clinical trial in overweight and obese individuals with type 2 diabetes, designed to evaluate the long-term effects (up to 11.5 years) of intensive weight loss interv ... Full text Cite

Cost and utilization outcomes of patients receiving hospital-based palliative care consultation.

Journal Article J Palliat Med · August 2006 Featured Publication OBJECTIVE: To compare per diem total direct, ancillary (laboratory and radiology) and pharmacy costs of palliative care (PC) compared to usual care (UC) patients during a terminal hospitalization; to examine the association between PC and ICU admission. DE ... Full text Link to item Cite

Distance as a barrier to using a fitness-program benefit for managed Medicare enrollees.

Journal Article J Aging Phys Act · July 2006 Featured Publication This study evaluated the effect of distance on the likelihood of initiating and maintaining regular use of a fitness-program benefit in a population of managed Medicare seniors. We studied 8,162 participants and nonparticipants in a managed-care fitness-pr ... Full text Link to item Cite

Estimating the VA total health care cost using a semi-parametric heteroscedastic two-part model

Journal Article Health Services and Outcomes Research Methodology · June 1, 2006 To appropriately assess the impact of the establishment of community-based outpatient clinics (CBOCs) on the total health care costs in a VA study, we need to deal with three methodological problems inherent in the data. The first problem is skewness of th ... Full text Cite

Comparison of risk adjustment measures based on self-report, administrative data, and pharmacy records to predict clinical outcomes

Journal Article Health Services and Outcomes Research Methodology · June 1, 2006 Comparing clinical outcomes in observational studies often requires adjustment for comorbid disease. The objective of this study was to compare the performance of risk adjustment measures derived from different data sources to predict the clinical outcomes ... Full text Cite

Correlates of health-related quality of life in overweight and obese adults with type 2 diabetes.

Journal Article Obesity (Silver Spring) · May 2006 Featured Publication OBJECTIVE: This paper describes and examines conceptually relevant correlates of health-related quality of life (HRQL) in overweight or obese persons with type 2 diabetes. Research Design and Procedures: The investigation was a cross-sectional study of 514 ... Full text Link to item Cite

Are primary care services a substitute or complement for specialty and inpatient services?

Journal Article Health Serv Res · October 2005 Featured Publication OBJECTIVE: To determine whether strategies designed to increase members' use of primary care services result in decreases (substitution) or increases (complementation) in the use and cost of other types of health services. STUDY SETTING: Encounter and cost ... Full text Link to item Cite

A structured review of randomized controlled trials of weight loss showed little improvement in health-related quality of life.

Journal Article J Clin Epidemiol · June 2005 Featured Publication OBJECTIVE: To estimate the effect of weight-loss interventions on health-related quality of life (HrQoL) in randomized controlled trials (RCTs); to conduct a meta-analysis of weight-loss treatment on depressive symptoms; and, to examine methodological and ... Full text Link to item Cite

The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures.

Journal Article Health Serv Res · June 2005 Featured Publication OBJECTIVE: To evaluate the performance of different prospective risk adjustment models of outpatient, inpatient, and total expenditures of veterans who regularly use Veterans Affairs (VA) primary care. DATA SOURCES: We utilized administrative, survey and e ... Full text Link to item Cite

An analysis of disenrollment from Medicare managed care plans by Medicare beneficiaries with diabetes.

Journal Article Med Care · May 2005 Featured Publication RESEARCH OBJECTIVE: The purpose of this work is to determine whether high-cost high-risk Medicare patients with diabetes in managed care plans disenroll more quickly than lower-cost lower-risk Medicare patients with diabetes. If high-cost high-risk patient ... Full text Link to item Cite

Changes in characteristics of veterans using the VHA health care system between 1996 and 1999.

Journal Article Health Res Policy Syst · April 18, 2005 Featured Publication BACKGROUND: The Department of Veterans Affairs' Veterans Health Administration (VHA) provides a health care safety net to veterans. This study examined changes in characteristics of veterans using the VHA health care system between 1996 and 1999 when VHA i ... Full text Link to item Cite

Impact of morbid obesity on medical expenditures in adults.

Journal Article Int J Obes (Lond) · March 2005 Featured Publication CONTEXT: Morbid obesity (body mass index (BMI) > or =40 kg/m2) is associated with substantially increased morbidity and mortality from chronic health conditions and with poorer health-related quality of life; however, less is known about the impact of morb ... Full text Link to item Cite

Predicting costs of Veterans Affairs health care in Gulf War veterans with medically unexplained physical symptoms.

Journal Article Mil Med · January 2005 Featured Publication Measures of post-traumatic stress disorder (PTSD) and depression were used to predict Veterans Affairs outpatient treatment costs among Persian Gulf War veterans with medically unexplained physical symptoms. Patients (N = 206) enrolled in a Veterans Affair ... Full text Link to item Cite

Does improving geographic access to VA primary care services impact patients' patterns of utilization and costs?

Journal Article Inquiry · 2005 Featured Publication The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inp ... Full text Link to item Cite

Multiple prior years of health expenditures and Medicare health plan choice.

Journal Article Int J Health Care Finance Econ · September 2004 Featured Publication This study examines the effect of multiple prior years of health expenditures on the probability of enrollment in a Medicare HMO. Beneficiaries may require more than one year of prior expenditure data to form a reliable estimate of future expenditures if h ... Full text Link to item Cite

Effectiveness of diabetic therapeutic footwear in preventing reulceration.

Journal Article Diabetes Care · July 2004 Featured Publication OBJECTIVE: To review the evidence for the effectiveness of therapeutic footwear in preventing foot reulceration in individuals with diabetes and foot risk factors. RESEARCH DESIGN AND METHODS: We conducted a structured literature review based on a Medline ... Full text Link to item Cite

Diabetes-related utilization and costs for inpatient and outpatient services in the Veterans Administration.

Journal Article Diabetes Care · May 2004 Featured Publication OBJECTIVE: -The purpose of this study was to calculate the total number of inpatient hospitalizations, outpatient clinic visits, and total direct health care costs associated with veterans with diabetes receiving care in Veterans Administration (VA) facili ... Full text Link to item Cite

Therapeutic footwear in patients with diabetes.

Journal Article JAMA · September 11, 2002 Link to item Cite

Disability and health care costs in the Medicare population.

Journal Article Arch Phys Med Rehabil · September 2002 Featured Publication OBJECTIVE: To determine the effect of activity limitations on health care expenditures. DESIGN: Cross-sectional. SETTING: National survey. PARTICIPANTS: Data from the 1997 Medicare Current Beneficiary Survey (n=9298), a nationally representative sample of ... Full text Link to item Cite

VA community-based outpatient clinics: cost performance measures.

Journal Article Med Care · July 2002 Featured Publication OBJECTIVE: To examine the direct costs of treating veterans in Community-Based Outpatient Clinics (CBOC) and primary care clinics operated by VA medical centers (VAMCs) between April 1998 and September 1998. RESEARCH DESIGN: In a retrospective observationa ... Full text Link to item Cite

Evaluation of the Department of Veterans Affairs community-based outpatient clinics.

Journal Article Med Care · July 2002 Featured Publication OBJECTIVE: This paper describes the history of the Department of Veterans Affairs (VA) Community-Based Outpatient Clinics (CBOCs), CBOC Performance Evaluation Project, and characteristics of CBOCs within the VA, and summarizes the findings and implications ... Full text Link to item Cite

VA community-based outpatient clinics: access and utilization performance measures.

Journal Article Med Care · July 2002 Featured Publication OBJECTIVES: The purpose of this study was to compare access and utilization performance measures between Community-Based Outpatient Clinics (CBOC) and primary care clinics at parent VA Medical Centers (VAMC) and between VA-staff CBOCs and contract CBOCs. M ... Full text Link to item Cite

Common methodological terms in health services research and their synonyms [correction of symptoms].

Journal Article Med Care · June 2002 Featured Publication OBJECTIVE: Health services researchers use methods and terminology from a variety of disciplines to understand individual and organizational behavior related to health, health care, and health insurance. Although this diversity benefits the process of rese ... Full text Link to item Cite

Effect of therapeutic footwear on foot reulceration in patients with diabetes: a randomized controlled trial.

Journal Article JAMA · May 15, 2002 Featured Publication CONTEXT: Many people with diabetes experience lower-limb ulcers. Footwear has been implicated as a primary cause of foot ulcers, yet research is limited on the efficacy of shoe and insert combinations to prevent reulceration. OBJECTIVE: To determine whethe ... Full text Link to item Cite

Footwear used by individuals with diabetes and a history of foot ulcer.

Journal Article J Rehabil Res Dev · 2002 Featured Publication OBJECTIVE: To describe footwear preferences of people with diabetes and a history of foot ulcer from two large western Washington State healthcare organizations. METHODS: As part of a clinical trial of footwear, self-reported information on footwear prefer ... Link to item Cite

Comparing mortality and time until death for medicare HMO and FFS beneficiaries.

Journal Article Health Serv Res · February 2001 Featured Publication OBJECTIVE: To compare adjusted mortality rates of TEFRA-risk HMO enrollees and disenrollees with rates of beneficiaries enrolled in the Medicare fee-for-service sector (FFS), and to compare the time until death for decedents in these three groups. DATA SOU ... Link to item Cite

Disenrollment from Medicare HMOs.

Journal Article Am J Manag Care · January 2001 Featured Publication BACKGROUND: Since the program's inception, there has been great interest in determining whether beneficiaries who enter and subsequently leave Medicare health maintenance organizations (HMOs) are more or less costly than those remaining in fee-for-service ... Link to item Cite

A demand-side view of risk adjustment.

Journal Article Inquiry · 2001 Featured Publication This paper analyzes the efficient allocation of consumers to health plans. Specifically, we address the question of why employers that offer multiple health plans often make larger contributions to the premiums of the high-cost plans. Our perspective is th ... Full text Link to item Cite

The effect of tax-exempt out-of-pocket premiums on health plan choice

Journal Article National Tax Journal · January 1, 2001 Market-based health care reform proposals typically rely on 1) consumer choice among competing health plans, 2) premiums paid out-of-pocket for higher priced plans, and 3) a significant out-of-pocket premium-price elasticity of health plan choice. Section ... Full text Cite

Selection experiences in Medicare HMOs: pre-enrollment expenditures.

Journal Article Health Care Financ Rev · 1999 Featured Publication Using 1993 and 1994 data, the authors examine whether beneficiaries who enroll in a Medicare health maintenance organization (HMO), including those enrolling for only a short period of time, have lower expenditures than continuous fee-for-service (FFS) ben ... Link to item Cite

The relationship of patient satisfaction with care and clinical outcomes.

Journal Article Med Care · July 1997 Featured Publication OBJECTIVES: The authors examine the relationship between three dimensions of patient satisfaction (quality of care, hospital care, and physician time) and two ways of looking at outcomes: absolute (status at 6 months after surgery) and relative (difference ... Full text Link to item Cite

How do states buy health insurance for their own employees?

Journal Article Manag Care Q · 1997 Featured Publication State governments play many roles in local health insurance markets. This paper focuses on the role of states as employers. As managed care and health care costs continue to grow, state governments engage in a variety of health insurance purchasing practic ... Link to item Cite