Guy David, Philip A. Saynisch, and Aaron Smith-McLallen. 2018. “The economics of patient-centered care.” Journal of health economics, 59, Pp. 60-77.Abstract
The Patient-Centered Medical Home (PCMH) is a widely-implemented model for improving primary care, emphasizing care coordination, information technology, and process improvements. However, its treatment as an undifferentiated intervention in policy evaluation obscures meaningful variation in implementation. This heterogeneity leads to contracting inefficiencies between insurers and practices and may account for mixed evidence on its success. Using a novel dataset we group practices into meaningful implementation clusters and then link these clusters with detailed patient claims data. We find implementation choice affects performance, suggesting that generally-unobserved features of primary care reorganization influence patient outcomes. Reporting these features may be valuable to insurers and their members.
Guy David, Philip Saynisch, Spencer Luster, Aaron Smith-McLallen, and Ravi Chawla. 2018. “The impact of patient‐centered medical homes on medication adherence.” Health Economics.Abstract
Accreditation of providers helps resolve the pervasive information asymmetries in health care markets. However, meeting accreditation standards typically involves flexibility in implementation, leading to heterogeneity in performance. For example, the patient‐centered medical home (PCMH) is a leading model for recognizing high‐performing primary care practices. Flexibility in PCMH implementation allows for varying degrees of emphasis on processes designed to enhance medication adherence. To assess the impact of the PCMH on adherence, we combine 6 years of detailed patient claims data with a novel dataset containing detailed practice‐level PCMH attributes. We study the effects of the number and configuration of adherence‐relevant capabilities, using variation in the timing of PCMH adoption to estimate its impact. While PCMH adoption improved overall medication adherence, when combining claims data with the unique recognition data detailing what PCMH capabilities were adopted, we find that these gains are concentrated among patients in practices that adopted more adherence‐relevant capabilities. Despite mixed evidence in the literature concerning costs and utilization, our results indicate that PCMH recognition improves medication adherence.
Peter Sands, Anas El Turabi, Philip A Saynisch, and Victor J Dzau. 2016. “Assessment of economic vulnerability to infectious disease crises.” The Lancet, 388, 10058, Pp. 2443–2448. Publisher's Version
Guy David, Candace Gunnarsson, Philip A. Saynisch, Ravi Chawla, and Somesh Nigam. 2015. “Do patient-centered medical homes reduce emergency department visits?” Health Services Research, 50, 2, Pp. 418–439.Abstract
OBJECTIVE: To assess whether adoption of the patient-centered medical home (PCMH) reduces emergency department (ED) utilization among patients with and without chronic illness. DATA SOURCES: Data from approximately 460,000 Independence Blue Cross patients enrolled in 280 primary care practices, all converting to PCMH status between 2008 and 2012. RESEARCH DESIGN: We estimate the effect of a practice becoming PCMH-certified on ED visits and costs using a difference-in-differences approach which exploits variation in the timing of PCMH certification, employing either practice or patient fixed effects. We analyzed patients with and without chronic illness across six chronic illness categories. PRINCIPAL FINDINGS: Among chronically ill patients, transition to PCMH status was associated with 5-8 percent reductions in ED utilization. This finding was robust to a number of specifications, including analyzing avoidable and weekend ED visits alone. The largest reductions in ED visits are concentrated among chronic patients with diabetes and hypertension. CONCLUSIONS: Adoption of the PCMH model was associated with lower ED utilization for chronically ill patients, but not for those without chronic illness. The effectiveness of the PCMH model varies by chronic condition. Analysis of weekend and avoidable ED visits suggests that reductions in ED utilization stem from better management of chronic illness rather than expanding access to primary care clinics.
Jo Ann D Agostino, Molly Passarella, Philip Saynisch, Ashley E Martin, and Michelle Macheras. 2015. “Preterm Infant Attendance at Health Supervision Visits.” Pediatrics, 136, 4.
Jeffrey H Silber, Paul R Rosenbaum, Richard N Ross, Justin M Ludwig, Wei Wang, Bijan A Niknam, Philip A Saynisch, Orit Even-shoshan, Rachel R Kelz, and Lee A Fleisher. 2014. “A Hospital-Specific Template for Benchmarking its Cost and Quality.” Health services research, 49, 5, Pp. 1475–1497.
PP Reese, RD Bloom, HI Feldman, P Rosenbaum, W Wang, P Saynisch, NM Tarsi, N Mukherjee, AX Garg, A Mussell, J Shults, RR Townsend, and JH Silber. 2014. “Mortality and Cardiovascular Disease Among Older Live Kidney Donors.” American Journal of Transplantation, 14, Pp. 1853–1861.
Jeffrey H. Silber, Paul R. Rosenbaum, Richard N. Ross, Justin M. Ludwig, Wei Wang, Bijan A. Niknam, Nabanita Mukherjee, Philip A. Saynisch, Orit Even-shoshan, Rachel R. Kelz, and Lee A. Fleisher. 2014. “Template matching for auditing hospital cost and quality.” Health Services Research, 49, 5, Pp. 1446–1474.Abstract
OBJECTIVE: Develop an improved method for auditing hospital cost and quality.$\backslash$n$\backslash$nDATA SOURCES/SETTING: Medicare claims in general, gynecologic and urologic surgery, and orthopedics from Illinois, Texas, and New York between 2004 and 2006.$\backslash$n$\backslash$nSTUDY DESIGN: A template of 300 representative patients was constructed and then used to match 300 patients at hospitals that had a minimum of 500 patients over a 3-year study period.$\backslash$n$\backslash$nDATA COLLECTION/EXTRACTION METHODS: From each of 217 hospitals we chose 300 patients most resembling the template using multivariate matching.$\backslash$n$\backslash$nPRINCIPAL FINDINGS: The matching algorithm found close matches on procedures and patient characteristics, far more balanced than measured covariates would be in a randomized clinical trial. These matched samples displayed little to no differences across hospitals in common patient characteristics yet found large and statistically significant hospital variation in mortality, complications, failure-to-rescue, readmissions, length of stay, ICU days, cost, and surgical procedure length. Similar patients at different hospitals had substantially different outcomes.$\backslash$n$\backslash$nCONCLUSION: The template-matched sample can produce fair, directly standardized audits that evaluate hospitals on patients with similar characteristics, thereby making benchmarking more believable. Through examining matched samples of individual patients, administrators can better detect poor performance at their hospitals and better understand why these problems are occurring.
Rachel R Kelz, Caroline E Reinke, José R Zubizarreta, Min Wang, Philip Saynisch, Orit Even-shoshan, Peter P Reese, Lee A Fleisher, and Jeffrey H Silber. 2013. “Acute kidney injury, renal function, and the elderly obese surgical patient: a matched case-control study.” Annals of surgery, 258, 2, Pp. 359–63. Publisher's VersionAbstract
{OBJECTIVE: To investigate the association between obesity and perioperative acute kidney injury (AKI), controlling for preoperative kidney dysfunction. BACKGROUND: More than 30% of patients older than 60 years are obese and, therefore, at risk for kidney disease. Postoperative AKI is a significant problem. METHODS: We performed a matched case-control study of patients enrolled in the Obesity and Surgical Outcomes Study, using data of Medicare claims enriched with detailed chart review. Each AKI patient was matched with a non-AKI control similar in procedure type, age, sex, race, emergency status, transfer status, baseline estimated glomerular filtration rate, admission APACHE score, and the risk of death score with fine balance on hospitals. RESULTS: We identified 514 AKI cases and 694 control patients. Of the cases, 180 (35%) followed orthopedic procedures and 334 (65%) followed colon or thoracic surgery. After matching, obese patients undergoing a surgical procedure demonstrated a 65% increase in odds of AKI within 30 days from admission (odds ratio = 1.65, P \textless 0.005) when compared with the nonobese patients. After adjustment for potential confounders, the odds of postoperative AKI remained elevated in the elderly obese (odds ratio = 1.68
Guy David, Phil Saynisch, Victoria Acevedo-Perez, and Mark D Neuman. 2012. “Affording to Wait: Medicare Initiation and the Use of Health Care.” Health Economics, 1036, July 2011, Pp. 1030–1036. Publisher's Version
JH Silber, PR Rosenbaum, and RR Kelz. 2012. “Medical and financial risks associated with surgery in the elderly obese.” Annals of surgery, 256, 1, Pp. 79–86. Publisher's Version
CE Reinke, RR Kelz, José R Zubizarreta, and Lanyu Mi. 2012. “Obesity and readmission in elderly surgical patients.” Surgery, 152, 3, Pp. 355–362. Publisher's Version