Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

Feb. 16, 2017

Brendan Saloner, Lisa Clemens Cope, Katherine Hempstead, Karin Rhodes, Daniel Polsky, Genevieve Kenney

In the Journal of General Internal Medicine, Brendan Saloner, Daniel Polsky, Karin Rhodes, and colleagues investigate whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices and geographic areas. Cost-sharing in insurance plans incentivizes patients to shop for lower prices, but can patients obtain price information when scheduling office visits? The authors used a simulated patient methodology in which trained interviewers posed as patients (with different types of insurance) seeking new primary care...

What Factors Affect Physicians’ Decisions to Prescribe Opioids in Emergency Departments?

Feb. 16, 2017

Lauren E Sinnenberg, Kathryn J Wanner, Jeanmarie Perrone, Frances K Barg, Karin Rhodes, Zachary Meisel

In MDM Policy & Practice, LDI Senior Fellows Zachary Meisel, Jeanmarie Perrone, Karin Rhodes, and colleagues assess the factors physicians consider when treating pain with opioids in the emergency department (ED).  With 42% of all ED visits in the United States related to pain, the ED is an ideal setting to target to curtail the current opioid overdose epidemic and develop opioid prescription guidelines and policies. The researchers interviewed 52 physicians at a national emergency medicine conference. They identified three main domains that contributed to the participants’...

The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors

Jan. 27, 2017

Christopher P. Bonafide,  David T. Jamison,  Elizabeth E. Foglia, 

In a JAMA Viewpoint, Christopher Bonafide and colleagues discuss the efficacy and safety of smartphone apps integrated with sensors that monitor infants’ vital signs. While the performance characteristics of these sensors are unknown to the public and the regulations around them are scarce, their sales have skyrocketed, reaching 40,000 units for a single brand of “smart sock” monitors. These companies use direct-to-parent advertising to portray their products as necessary to alert parents when something is wrong with their infants’ cardiorespiratory health, even though there are...

Biomarker-Defined Subsets of Common Diseases: Policy and Economic Implications of Orphan Drug Act Coverage

Jan. 20, 2017

Aaron S. Kesselheim, Carolyn L. Treasure, Steven Joffe

In PLOS Medicine, Aaron Kesselheim and colleagues, including LDI senior fellow Steven Joffe, investigate the policy and economic implications of the Orphan Drug Act of 1983, and examine the circumstances surrounding a drug’s discovery and development, secondary approvals, off label uses, subsequent revenues, and the reported monthly cost of biomarker-defined disease subsets. The Orphan Drug Act of 1983 was intended to incentivize the development of pharmaceutical products for rare diseases by providing manufacturers with the opportunity to earn grants, tax credits, free waivers,...

A Trial of Financial and Social Incentives to Increase Older Adults’ Walking

Jan. 20, 2017

Kristin A. Harkins, Jeffrey T. Kullgren, Scarlett L. Bellamy, Jason Karlawish, Karen Glanz

In the American Journal of Preventive Medicine, Kristin Harkins and colleagues, including LDI Senior Fellows Jason Karlawish and Karen Glanz, investigate the effects of financial incentives and donations to charity separately and combined on older adults’ uptake and retention of increased levels of walking. Despite evidence that regular physical activity confers health benefits, physical activity rates among older adults remain low. Both personal and social goals may enhance older adults’ motivation to become active. Ninety-four participants aged ≥65 years participated in this...

Mental Health Conditions and Medical and Surgical Hospital Utilization

Jan. 19, 2017

Stephanie K. Doupnik, John Lawlor, Bonnie Zima, Tumaini Coker, Naomi Bardach, Matt Hall, Jay Berry

In Pediatrics, LDI Fellow Stephanie Doupnik and colleagues examine how the presence of comorbid mental health conditions affect hospitalizations and costs. Using the 2012 Kids’ Inpatient Database, the authors conducted a retrospective, cross-sectional study of 670,161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. They estimated the association of a comorbid mental health condition with length of stay using generalized linear models and the cost of additional hospital days associated with mental health conditions using...

Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology

Jan. 19, 2017

Salman Zaheer, Samuel Pimentel, Kristina Simmons, Lindsay Kuo, Jashodeep Datta, Noel Williams, Douglas Fraker, Rachel Kelz

In Annals of Surgery, Salman Zaheer and colleagues, including LDI Senior Fellow Rachel Kelz, compare surgical outcomes of international medical graduates (IMGs) and United States medical graduates (USMGs). Medical education outside of the US is substantially different from that in the US and usually begins right after high school and lasts for 5 to 7 years. This is the first study to examine differences in surgical outcomes of patients treated by IMGs and USMGs. The authors used a unique dataset linking AMA Physician Masterfile data with hospital discharge claims from Florida and...

Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline

Jan. 17, 2017

Alexander G. Fiks, Michelle E. Ross, Stephanie L. Mayne, Lihai Song,Weiwei Liu, Jennifer Steffes, Banita McCarn, Robert W. Grundmeier, A. Russell Localio, Richard Wasserman

In Pediatrics, LDI Senior Fellow Alexander Fiks and colleagues evaluate the change in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and in the prescribing of stimulants to children 4 to 5 years old after release of the 2011 American Academy of Pediatrics guideline. The authors use electronic health record data extracted from 63 primary care practices, including preventive visits from children 48 to 72 months old receiving care from January 2008 to July 2014, to compare rates of ADHD diagnosis and stimulant prescribing before and after guideline release. Among 87...

Diagnosis and Medication Treatment of Pediatric Hypertension: A Retrospective Cohort Study

Jan. 2, 2017

David C. Kaelber, Weiwei Liu, Michelle Ross, A. Russell Localio, Janeen B. Leon, Wilson D. Pace, Richard C. Wasserman, Alexander G. Fiks

In Pediatrics, David Kaelber and colleagues, including LDI Senior Fellow Alexander Fiks, evaluate the diagnosis and initial medication management of pediatric hypertension and prehypertension in primary care. Pediatric hypertension predisposes children to adult hypertension and early markers of cardiovascular disease. Hypertension and pre-hypertension are well-defined, prevalent and generally asymptomatic conditions in children and adolescents that often go undiagnosed and untreated with...

Comparing the contributions of acute and post acute care facility characteristics to outcomes after hospitalization for hip fracture

Jan. 2, 2017

Neuman, Mark D.; Silber, Jeffrey H.; Passarella, Molly R.; Werner, Rachel M.

In Medical Care, LDI Senior Fellows Mark Neuman, Jeffrey Silber and Rachel Werner and colleagues quantify the contribution of acute versus post acute care factors to survival and functional outcomes after hip fracture. This retrospective cohort study was conducted using Medicare data from previously ambulatory nursing home residents hospitalized for hip fracture between 2005 and 2009. The authors measured the associations of hospital and nursing home factors with functional and survival outcomes at 30 and 180 days among patients discharged to a nursing facility,...

False Dichotomies and Health Policy Research Designs: Randomized Trials Are Not Always the Answer

Dec. 31, 2016

Stephen B. Soumerai, Rachel Ceccarelli, and Ross Koppel

In the Journal of General Internal Medicine, Stephen Soumerai and colleagues, including LDI Senior Fellow Ross Koppel, highlight the benefits of using quasi-experimental designs and observational data when a study neither permits or requires a randomized controlled trial (RCT). Using Campbell and Stanley’s classic research design monograph, which classifies research as randomized experiments, strong quasi-experiments, and weak pre-experiments, the authors provide a simple hierarchy of common strong and weak designs, with RCTs and interrupted time series (ITS) both classified as...

Evaluating the Impact of Florida’s “Stand Your Ground” Self-defense Law on Homicide and Suicide by Firearm: An Interrupted Time Series Study

Dec. 5, 2016

David K. Humphreys, Antonio Gasparrini, Douglas J. Wiebe

In JAMA Internal Medicine, Douglas Wiebe and colleagues estimate the impact of Florida’s stand your ground law on rates of homicide and homicide by firearm. In 2005, Florida became the first state to amend its self-defense laws to provide legal immunity to individuals using lethal force in self-defense. Using an interrupted time-series design, the authors analyzed monthly rates of homicide and homicide by firearm between 1999 and 2014 extracted from the CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER), and assessed the association between the onset of the law (...

The Anticipatory Effects of Medicare Part D on Drug Utilization

Dec. 1, 2016

Abby Alpert

In the Journal of Health Economics, Abby Alpert examines anticipation effects of Medicare Part D, which went into effect two years after it was signed into law. This potentially gave forward-looking individuals time to change their drug consumption behavior in anticipation of future subsidized drug coverage. This approach contrasts with prior studies of Part D, which do not take the possibility of behavioral responses to the announcement into consideration, thus...

A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial

Nov. 20, 2016

Stephen E. Kimmel, Andrea B. Troxel, Benjamin French, George Loewenstein, Jalpa A. Doshi, Todd E. H. Hecht, Mitchell Laskin, Colleen M. Brensinger, Chris Meussner, Kevin Volpp

In Pharmacoepidemiology and Drug Safety, Stephen Kimmel and colleagues, including Jalpa Doshi, Benjamin French and Kevin Volpp, investigate the comparative effectiveness of reminders alone versus daily lottery incentives in improving medication adherence. This study was a four-arm multi-center...