Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting

SPATIAL ACCESSIBILITY OF HEALTH CARE IN INDIANA

Healthy populations and access to health care services are significant factors influencing economic development and prosperity. Since geographic access is an essential feature of an overall health system, it is important for health service researchers to develop accurate measures of physical access to health. In this paper we develop a series of gravity-based health care accessibility measures for all the counties in Indiana. The measures go beyond local availability of health care services within a county and account for travel impedance via distance-discounted health care services accessible throughout the state. When applied to Indiana counties, the results show sharp disparities in health care accessibility with extensive pockets of poor accessibility in rural and peripheral areas. The research concludes with a demonstration of how spatial accessibility measures can be beneficially used to evaluate of policies indicative of changes in the provision of health services.spatial accessibility, health care, geographic information systems (GIS),

How Managed Care Affects Medicaid Utilization: A Synthetic Difference-in-Difference Zero-Inflated Count Model

We develop a synthetic difference-in-differences statistical design to apply to experimental data for adult women living in Hennepin County, Minnesota, to estimate the impact of Medicaid managed care on various modes of medical care use.Because the outcomes of interest are utilization counts with many persons using none of a particular mode of care we use count regression models that are adjusted for excessive zeros.We find no reductions in physician visits or hospital inpatient and emergency department care use, but reductions in hospital outpatient care.Simulations designed to judge the economic significance of our results suggest a program effect that is a savings of about ten percent.health;statistical methods