Treatment and Outcomes for Congestive Heart Failure by Race/Ethnicity in TRICARE

Bagchi, Ann D.; Stewart, Kate; McLaughlin, Catherine G.; Higgins, Patricia; Croghan, Thomas W.

doi:10.1097/mlr.0b013e318207ef87

Cited by 36 publications

(28 citation statements)

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“…As a claims-based registry, we recognize that we do not have any information on radiographic findings, severity of disease, disability or pain scores, or procedural rationale. However, there is no evidence to support the contention that the rationale for surgical intervention or approaches to care differs between the fee-for-service and direct care settings [3,18,22]. Lastly, other than documenting differences in procedural selection between fee-for-service and salaried surgeons, we cannot truly elucidate their underlying motivations.…”

Section: Discussionmentioning

confidence: 89%

“…The MDR captures all information on inpatient and outpatient insurance claims handled through TRICARE irrespective of the environment of care or the location of service. TRICARE data have previously been utilized in other initiatives evaluating the delivery of surgical services in a number of different contexts [3,18,22]. Moreover, the broad demographic insured through TRICARE, which covers individuals of extremely varied sociodemographic, educational, professional, and vocational backgrounds, has been considered representative of the American population aged 18 to 64 years in prior studies [3,16,18,22].…”

Section: Methodsmentioning

confidence: 99%

“…TRICARE insurance is provided to all uniformed military employees of the DoD and their dependents as well as retirees and those separated as a result of a medical condition associated with greater than 30% disability [3,18,22]. TRICARE beneficiaries may receive care in the fee-for-service civilian setting (purchased care) or through a DoD medical facility (direct care) [3,18,22].…”

Section: Methodsmentioning

confidence: 99%

“…This may be the result of the fact that it is often difficult to determine physician compensation through claims-based data capable of tracking large-scale variation in procedural performance. The TRICARE insurance plan of the Department of Defense (DoD) may serve as a more effective setting to investigate this phenomenon, however, given that the program functions within two different environments of care: purchased care in which beneficiaries receive services at civilian centers in the fee-forservice system and direct care in which services are provided at DoD facilities where providers are salaried employees or contractors of the DoD [3,18,22]. TRI-CARE is also a useful medium in which to conduct this research because the universal insurance coverage and benefits provided through the DoD eliminate an important confounder in surgical decision-making [3,7,18,20,22].…”

Section: Introductionmentioning

confidence: 99%

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Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Schoenfeld

Makanji

Jiang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. Questions/purposes (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? Methods Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-forservice setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication. Results TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service Conclusions The preferential use of interbody fusion procedures was higher in the fee-for-service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable CareThis study was supported in part by a grant from the Henry M. Jackson Foundation of the Department of Defense (AHH). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at

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Section: Discussionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Schoenfeld

Makanji

Jiang

et al. 2017

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…However, risk factor modification can be challenging, especially when the targeted community is either uninsured or lacks the necessary resources (Rodriguez et al, 2011). Bagchi et al (2011) suggested that equal access to care may mitigate health disparities among the varying ethnic HF patients. Historically, minority groups have faced challenges in accessing health care.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Insurance Type among Minorities for Congestive Heart Failure Diagnosis in the Ambulatory Care Setting

O’Lawrence

Martínez

Solis

2017

European Journal of Environment and Public Health

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Background: Lack of access to healthcare, health insurance and health providers and access to quality healthcare is strongly related to socioeconomic inequalities. These inequities are thought to reflect social and economic disparities more than biological differences associated with the race of the individuals. Purpose: The purpose of this study was to determine the associations between ethnicity/race and method of payment with the diagnosis of new onset heart failure in the ambulatory care setting. Health care disparities have been well documented to exist in various demographics and socioeconomic statuses. Specifically, there are differences in access to and quality of healthcare between ethnic and racial groups; and additionally, the quantity and quality of care that a patient receives is dependent on the patients' insurance status. Methods: Data sets for this study were retrieved from the 2010 Centers for Disease Control and Prevention [CDC's] National Ambulatory Medical Care Survey (NAMCS) -as this is the most recent data available for analysis. The IBM SPSS Version 20.0 statistical software was used to conduct the analysis of the data. Crosstabulation of the dependent and independent variables was completed to examine the prevalence of CHF diagnosis by insurance type and ethnicity/race. Correlation tests were run to determine if any significant correlations between the variable existed in the target population. Lastly, Chi-Square tests were analyzed on the independent variable to determine if there was a statistically significant association with the dependent variable. Result: The results supported past research which found that racial, ethnic, and socioeconomic disparities exist in health care. The data demonstrates the number of respondents' self-identified ethnicity/race cross referenced with the corresponding method of payment. In addition, the number of respondents' self-identified ethnicity/race was cross referenced with the number of new diagnosis of CHF. Conclusion: Disparities in the diagnosis of CHF are significantly associated with ethnicity, race, and insurance status. The results demonstrate that substantial differences exist between ethnicities and race in the diagnosis of CHF. Further, substantial differences were discovered in the diagnosis of CHF between the privately insured, publically insured, and the uninsured.

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Incidence and Predictors of Opioid Prescription at Discharge After Traumatic Injury

et al. 2017

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Treatment and Outcomes for Congestive Heart Failure by Race/Ethnicity in TRICARE

Cited by 36 publications

References 0 publications

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Disparities in Insurance Type among Minorities for Congestive Heart Failure Diagnosis in the Ambulatory Care Setting

Incidence and Predictors of Opioid Prescription at Discharge After Traumatic Injury

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