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    Assessing And Modeling Quality Measures for Healthcare Systems

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    Name:
    Nien_Chen_Li_PhD_thesis_Assess ...
    Embargo:
    2023-12-30
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    1.479Mb
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    Authors
    Li, Nien-Chen
    Faculty Advisor
    Arlene Ash
    Academic Program
    Clinical and Population Health Research
    UMass Chan Affiliations
    Clinical and Population Health Research, Graduate School of Biomedical Sciences
    Document Type
    Doctoral Dissertation
    Publication Date
    2021-11-06
    Keywords
    quality measure
    community tenure
    risk adjustment
    zero-inflated regression models
    doubly augmented beta model
    deviance
    Vuong test
    r-square
    O/E ratio
    predictive probability
    bipolar disorder
    second-generation antipsychotics
    medication possession ratio
    risk factors
    social determinants of health
    Biostatistics
    Medicine and Health Sciences
    Mental and Social Health
    Statistical Models
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    Abstract
    Background: Shifting the healthcare payment system from a volume-based to a value-based model has been a significant effort to improve the quality of care and reduce healthcare costs in the US. In 2018, Massachusetts Medicaid launched Accountable Care Organizations (ACOs) as part of the effort. Constructing, assessing, and risk-adjusting quality measures are integral parts of the reform process. Methods: Using data from the MassHealth Data Warehouse (2016-2019), we assessed the loss of community tenure (CTloss) as a potential quality measure for patients with bipolar, schizophrenia, or other psychotic disorders (BSP). We evaluated various statistical models for predicting CTloss using deviance, Akaike information criterion, Vuong test, squared correlation and observed vs. expected (O/E) ratios. We also used logistic regression to investigate risk factors that impacted medication nonadherence, another quality measure for patients with bipolar disorders (BD). Results: Mean CTloss was 12.1 (±31.0 SD) days in the study population; it varied greatly across ACOs. For risk adjustment modeling, we recommended the zero-inflated Poisson or doubly augmented beta model. The O/E ratio ranged from 0.4 to 1.2, suggesting variation in quality, after adjusting for differences in patient characteristics for which ACOs served as reflected in E. Almost half (47.7%) of BD patients were nonadherent to second-generation antipsychotics. Patient demographics, medical and mental comorbidities, receiving institutional services like those from the Department of Mental Health, homelessness, and neighborhood socioeconomic stress impacted medication nonadherence. Conclusions: Valid quality measures are essential to value-based payment. Heterogeneity implies the need for risk adjustment. The search for a model type is driven by the non-standard distribution of CTloss.
    DOI
    10.13028/8w3v-vd74
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/31399
    Rights
    Copyright is held by the author, with all rights reserved.
    ae974a485f413a2113503eed53cd6c53
    10.13028/8w3v-vd74
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    Morningside Graduate School of Biomedical Sciences Dissertations and Theses

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