Association Between Imposition of a Maintenance of Certification Requirement and Ambulatory Care–Sensitive Hospitalizations and Health Care Costs

Gray, Bradley; Vandergrift, Jonathan L.; Johnston, Mary M.; Reschovsky, James D.; Lynn, Lorna A.; Holmboe, Eric S.; McCullough, Jeffrey S.; Lipner, Rebecca S.

doi:10.1001/jama.2014.12716

Cited by 62 publications

(44 citation statements)

References 26 publications

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“…(1) Hospitalizations for these conditions are understood as preventable, since the causes should be handled at a primary level of care. Therefore, these hospitalizations have been widely used as indicators of the impact of public policies and the accessibility and quality of basic health services.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, these hospitalizations have been widely used as indicators of the impact of public policies and the accessibility and quality of basic health services. (1)(2)(3) In the field of child health, hospitalizations for ACSC indicate poor attention in primary care, especially since children are considered a priority due to their susceptibility to illness. (4) The importance of primary care for the prevention of hospitalizations is emphasized in several studies, such as one conducted in the United States, which concluded that children who were attended by ambulatory care teams with preventive actions and early detection of health problems had a significant reduction in hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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Hospitalizações de crianças por condições evitáveis no Estado do Paraná: causas e tendência

et al. 2017

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Objective: To analyze the trends of hospitalizations for ambulatory care-sensitive conditions, according to the main causes among children under five years old. Method: Ecological time-series study carried out with data from the Hospital Information System of the State of Parana. The analysis was based on hospitalization rates and polynomial regression models according to age and cause. Results: The most frequent causes were pneumonia, gastroenteritis, asthma, kidney and urinary tract infection and nutritional disorders. Hospitalizations for pneumonia, asthma and nutritional deficiencies decreased among children under five and hospitalizations rates for gastroenteritis remained stable. There was an increase in hospitalization rates for kidney and urinary tract infection in all ages. Conclusion: Hospitalization for care-sensitive conditions among children under five years presented an increasing trend only for children under one year old. Hospitalizations for pneumonia, gastroenteritis, asthma and nutritional deficiencies showed a decreasing trend. ResumoObjetivo: Analisar a tendência das hospitalizações por condições sensíveis à atenção primária, segundo principais causas em menores de cinco anos. Métodos: Estudo de séries temporais do tipo ecológico realizado com dados do Sistema de Informação Hospitalar do Estado do Paraná. A análise ocorreu a partir das taxas de hospitalização e de modelos de regressão polinomial segundo idade e causa. Resultados: As causas mais frequentes foram pneumonias, gastrenterites, asma, infeção no rim e trato urinário e deficiências nutricionais. As hospitalizações por pneumonia, asma e deficiências nutricionais em menores de cinco anos reduziram e por gastroenterites mantiveram-se estáveis. Houve aumento nas taxas de hospitalização por infecção no rim e trato urinário em todas as idades. Conclusão: A tendência de hospitalização por condições sensíveis em menores de cinco anos foi crescente apenas para as crianças menores de um ano. As hospitalizações por pneumonias, gastroenterites, asma e deficiências nutricionais apresentaram tendência decrescente.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hospitalizações de crianças por condições evitáveis no Estado do Paraná: causas e tendência

et al. 2017

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“…While lifelong learning for all physicians matters greatly, the added quality or value achieved through these requirements is unclear [28][29][30]. Regardless, bureaucratic requirements certainly generate considerable expense, paperwork, and, perhaps most egregious, loss of precious time [31].…”

Section: Discussionmentioning

confidence: 99%

Bureaucrapathologies: Galloping Regulosis, Assessment Degradosis, and Other Unintended Organizational Maladies in Post-Graduate Medical Education

Yager

Katzman

2015

Acad Psychiatry

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As decadelong observers of evolving administrative regulations governing academic medicine, the authors have identified several organizational disorders they define as "bureaucrapathologies," pathological conditions caused by dysfunctional bureaucratic processes that generate excesses of wasted time, effort, and other resources. Appearing wherever bureaucratic organizations exist, they have become particularly egregious in health care, research, and education. In past decades, graduate medical education has been beset by proliferating assessment requirements accompanied by corresponding documentation requirements imposed by academic educational regulatory agencies (specifically the Accreditation Council on Graduate Medical). Although originating from the best of intentions, these largely untested, unvalidated, and unfunded mandates generate burdensome personnel, time, and resource requirements. As they trickle down organizational levels, the intentions of the originators are inevitably degraded. As motivations and incentives of lower level administrators and faculty differ considerably from those at higher levels, we inevitably encounter debatable assessment practices yielding results of dubious reliability and validity. These processes invariably lead to proliferating reports and paperwork. All of this raises serious questions about the benefits vs. harms of these enterprises. In our view, these pathogenic processes can be recognized as diagnosable subtypes of bureaucrapathology. Here the authors briefly describe two, Galloping Regulosis and Assessment Degradosis, which reflect on their pathogenesis and offer preliminary thoughts for potential remedies. Several other recently identified bureaucrapathological syndromes awaiting future delineation are noted.

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“…Several studies have shown no difference in outcomes for patients cared for by internists with ABIM time-limited vs time-unlimited certifi cates across a panel of ten primary care performance measures [ 21 ], and no difference in ambulatory care-sensitive hospitalizations when comparing internists with ABIM time-unlimited and time-limited certifi cates [ 22 ], though there was a small reduction in the growth differences of costs for a cohort of Medicare benefi ciaries [ 22 ]. Diplomates of American Board of Family Medicine ( ABFM ) who completed Performance in Practice modules related to hypertension showed improvement in most quality measures evaluated; however, though most had chosen lipid control as their quality improvement focus, no improvement was seen for that particular measure [ 23 ].…”

Section: Is the Moc Program Performing As It Should?mentioning

confidence: 99%

Maintenance of Certification: Current Status and Future Considerations

Rakinic¹,

Buie

2016

The ASCRS Textbook of Colon and Rectal Surgery

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Association Between Imposition of a Maintenance of Certification Requirement and Ambulatory Care–Sensitive Hospitalizations and Health Care Costs

Abstract: Imposition of the MOC requirement was not associated with a difference in the increase in ACSHs but was associated with a small reduction in the growth differences of costs for a cohort of Medicare beneficiaries.

Cited by 62 publications

References 26 publications

Hospitalizações de crianças por condições evitáveis no Estado do Paraná: causas e tendência

Hospitalizações de crianças por condições evitáveis no Estado do Paraná: causas e tendência

Bureaucrapathologies: Galloping Regulosis, Assessment Degradosis, and Other Unintended Organizational Maladies in Post-Graduate Medical Education

Maintenance of Certification: Current Status and Future Considerations

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