Impact of Mandated Public Reporting in California on 30-Day readmission following CABG surgery: A Health policy analysis

The 30-day all-cause readmission rate following coronary artery bypass graft (CABG) surgery is considered an important outcome measure for patients because higher rates can be an indicator of low quality and unnecessary health care costs. Our research uses rigorous methods to explore the impact of mandatory public reporting of all-cause readmission rates following CABG surgery in California. We used a hierarchical logistic regression model on 173, 823 CABG patient records. This model standardised outcomes across 10 U.S. states that were not previously comparable due to different CABG definitions and metrics. Additionally, in order to account for the differences in medical practice across different states, we applied a differencein-difference method to estimate the impact of public reporting. Finally, a recycled prediction method was used to estimate the number of averted readmissions following public reporting initiation in California

Primary Care Access to New Patient Appointments for California Medicaid Enrollees: A Simulated Patient Study

PurposeWe undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion.MethodsWe placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses. We developed multilevel, mixed-effect models to evaluate variation in appointment access. Multiple linear regression was used to examine the relationship between primary care access and ED use by county.ResultsAvailability of PCC new patient appointments to Medi-Cal enrollees lacking a PCC varied significantly across counties in the multilevel model, ranging from 77 enrollees (95% CI, 70-81) to 472 enrollees (95% CI, 378-628) per each available new patient appointment. Just 19% of PCCs had available appointments within the state-mandated 10 business days. Clinicians at Federally Qualified Health Centers had higher availability of new patient appointments (rate ratio = 1.56; 95% CI, 1.24-1.97). Counties with poorer PCC access had higher ED use by Medi-Cal enrollees.ConclusionsIn contrast to findings from other states, access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees

Achieving weight loss through a community-based, telewellness programme: A randomised controlled trial

Objectives: To (1) determine the weight-reducing effect of the Koa Family Program (KFP), a community-based, telewellness obesity intervention and (2) examine the impact of the KFP on improving weight-related health indicators. Design: Randomised controlled trial. Setting: Community-based in Sacramento, California, USA. Methods: Seventy women with overweight or obesity (25 ⩽ BMI < 40), aged 21–45 years and with low income (⩽ 185% of the US Federal Poverty Level) were randomly assigned to an intervention (n = 34) or control (n = 36) group. Data were collected by phone-administered questionnaire at weeks 0, 18 and 25. The intervention consisted of three components: (1) weekly, health coach-led, health education meetings on Zoom; (2) social media support through texting and private Facebook groups; and (3) a tree planting and stewardship campaign. The treatment effect on outcome measures (95% confidence intervals) was analysed with adjustment for variables including age, race/ethnicity, education and intake of fruit and vegetables. Results: The overall treatment effect of the KFP was weight loss at both Week 18 (–7.69 pounds [p <.000; 95% confidence interval (CI) = −11.97 to −3.41]) and Week 25 (−7.72 pounds [p =.002; 95% CI = −13.02 to −2.42]) of the study. KFP-associated improvements in diet, physical activity, stages of change and self-efficacy were also observed. Conclusions: The KFP resulted in weight loss significant at individual and population levels

California Health Benefits Review Program Analysis of California Assembly Bill AB 374 Step Therapy Coverage

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Program-Specific Cost-Effectiveness Analysis: Breast Cancer Screening Policies for a Safety-Net Program

AbstractBackgroundEvery Woman Counts (EWC), a California breast cancer screening program, faced challenging budget cutbacks and policy choices.MethodsA microsimulation model evaluated costs, outcomes, and cost-effectiveness of EWC program mammography policy options on coverage for digital mammography (which has a higher cost than film mammography but recent legislation allowed reimbursement at the lower film rate); screening eligibility age; and screening frequency. Model inputs were based on analyses of program claims data linked to California Cancer Registry data, Surveillance, Epidemiology, and End Results data, and the Medi-Cal literature. Outcomes included number of procedures, cancers, cancer deaths, costs, and incremental cost per life-year.ResultsProjected model outcomes matched program data closely. With restrictions on the number of clients screened, strategies starting screening at age 40 years were dominated (not cost-effective). This finding was highly robust in sensitivity analyses. Compared with no screening, biennial film mammography for women aged 50 to 64 years was projected to reduce 15-year breast cancer mortality by nearly 7.8% at $18,999 per additional life-year, annual film mammography was$106,428 per additional life-year, and digital mammography $180,333 per additional life-year. This more effective, more expensive strategy was projected to reduce breast cancer mortality by 8.6$17,050.ConclusionsFor the EWC program, biennial screening mammography starting at age 50 years was the most cost-effective strategy. The impact of digital mammography on life expectancy was small. Program-specific cost-effectiveness analysis can be completed in a policy-relevant time frame to assist policymakers faced with difficult program choices