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dc.contributor.advisorArlene Ash
dc.contributor.authorLi, Nien-Chen
dc.date2022-08-11T08:08:39.000
dc.date.accessioned2022-08-23T16:03:02Z
dc.date.available2022-08-23T16:03:02Z
dc.date.issued2021-11-06
dc.date.submitted2021-12-30
dc.identifier.doi10.13028/8w3v-vd74
dc.identifier.urihttp://hdl.handle.net/20.500.14038/31399
dc.description.abstractBackground: 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.
dc.language.isoen_US
dc.rightsCopyright is held by the author, with all rights reserved.
dc.subjectquality measure
dc.subjectcommunity tenure
dc.subjectrisk adjustment
dc.subjectzero-inflated regression models
dc.subjectdoubly augmented beta model
dc.subjectdeviance
dc.subjectVuong test
dc.subjectr-square
dc.subjectO/E ratio
dc.subjectpredictive probability
dc.subjectbipolar disorder
dc.subjectsecond-generation antipsychotics
dc.subjectmedication possession ratio
dc.subjectrisk factors
dc.subjectsocial determinants of health
dc.subjectBiostatistics
dc.subjectMedicine and Health Sciences
dc.subjectMental and Social Health
dc.subjectStatistical Models
dc.titleAssessing And Modeling Quality Measures for Healthcare Systems
dc.typeDoctoral Dissertation
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=2176&context=gsbs_diss&unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/gsbs_diss/1166
dc.legacy.embargo2023-12-30T00:00:00-08:00
dc.identifier.contextkey27057955
refterms.dateFOA2022-08-24T03:44:33Z
html.description.abstract<p><strong>Background:</strong></p> <p>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.</p> <p><strong>Methods:</strong></p> <p>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,<strong> </strong>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).</p> <p><strong>Results:</strong></p> <p>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.</p> <p><strong>Conclusions:</strong></p> <p>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.</p>
dc.identifier.submissionpathgsbs_diss/1166
dc.contributor.departmentClinical and Population Health Research, Graduate School of Biomedical Sciences
dc.description.thesisprogramClinical and Population Health Research
dc.identifier.orcid0000-0002-9632-9286


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