American journal of medical quality : the official journal of the American College of Medical Quality, 2016
A number of quality rating systems to rank health care providers have been developed over the yea... more A number of quality rating systems to rank health care providers have been developed over the years with the intention of helping consumers make informed health care purchasing decisions. Many use sets of individual quality measures to calculate a global rating. The utility of a global rating for consumer choice hinges on the relationships among included measures and the extent to which they jointly reflect an underlying dimension of quality. Publicly reported data on 4 quality domains-complication, mortality, readmission, and patient safety-from Centers for Medicare & Medicaid Services' Hospital Compare website were used to examine correlations among individual measures within each measure group (within-group correlations) and correlations between pairs of measures across different measure groups (between-group correlations). Modest within-group correlations were found in only 2 domains (mortality and readmission), and there were no meaningful between-group associations. These ...
Beginning January 1st, 2011 in the U.S. the Affordable Care Act enhanced Medicare coverage for pr... more Beginning January 1st, 2011 in the U.S. the Affordable Care Act enhanced Medicare coverage for preventive services by eliminating patient cost-sharing under Part B and by introducing an "Annual Wellness Visit," also free-of-charge. We evaluated the early effects of these reforms on utilization of preventive services. We analyzed nationally representative data on 15,044 Medicare seniors from the 2008-2010, and 2012 Medical Expenditure Panel Survey, and examined self-reported cholesterol test, blood pressure check, flu vaccination, endoscopy, fecal occult blood test, prostate specific antigen test, breast examination, and mammography. Enhanced Medicare benefits had no effects on preventive services utilization among Medicare seniors in 2012, including those with traditional Medicare and no other supplemental insurance, who stood to benefit the most from Part B enhancements. The muted overall response can be partly attributed to the fact that most seniors already held insuran...
Objectives:To systematically review the scientific evidence on efficacy, safety, and comparative ... more Objectives:To systematically review the scientific evidence on efficacy, safety, and comparative effectiveness of various types of bariatric surgery for treating adult patients with a body mass index (BMI) of 30.0 to 34.9 kg/m2 and diabetes or impaired glucose tolerance (IGT) and to compare effectiveness of surgery versus nonsurgical interventions in this population.
Using the Hospital Compare overall hospital quality star ratings and other publicly available dat... more Using the Hospital Compare overall hospital quality star ratings and other publicly available data on acute care hospitals, we examined star ratings for the flagship hospitals of a set of multihospital health systems in the United States. We compared star ratings and hospital characteristics of flagship and nonflagship hospitals across and within 113 health systems. The system flagship hospitals had significantly lower star ratings than did nonflagship hospitals, and they did not generally have the highest star ratings in their own systems. Higher teaching intensity, larger bed size, higher uncompensated care, and higher disproportionate share hospital (DSH) patient percentage were all significantly associated with lower star ratings of flagship hospitals when compared with nonflagship hospitals across all health systems; the flagship hospital of a system was more likely to have the lowest star rating in its system if the difference in DSH percentage was relatively large between the...
Cataracts account for about half of all cases of blindness worldwide, with the vast majority in d... more Cataracts account for about half of all cases of blindness worldwide, with the vast majority in developing countries, where blindness and visual impairment can reduce life expectancy and economic productivity. Most of these cases can be cured by quick, inexpensive surgical procedures, but a shortage of trained surgeons makes it unlikely that the need for such surgeries-estimated to reach 32 million cases globally by 2020-can be met under current practices. HelpMeSee Inc. (HMS) is developing an approach to surgery training and delivery that includes use of high-fidelity simulator technology and associated curricula for high-volume training, development of a system of independent private practitioners, and training where necessary of individuals without medical degrees. RAND researchers determined that the program has the potential to scale up surgical capacity rapidly and that under optimistic assumptions, the HMS program could largely close the backlog of surgical cases in the four ...
This systematic review sought to identify the best available evidence regarding strategies for al... more This systematic review sought to identify the best available evidence regarding strategies for allocating scarce resources during mass casualty events (MCEs). Specifically, the review addresses the following questions: (1) What strategies are available to policymakers to optimize the allocation of scarce resources during MCEs? (2) What strategies are available to providers to optimize the allocation of scarce resources during MCEs? (3) What are the public's key perceptions and concerns regarding the implementation of strategies to allocate scarce resources during MCEs? (4) What methods are available to engage providers in discussions regarding the development and implementation of strategies to allocate scarce resources during MCEs? We searched Medline, Scopus, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Global Health, Web of Science®, and the Cochrane Database of Systematic Reviews from 1990 through 2011. To identify relevant non-peer-reviewed rep...
Background: Despite many studies reporting disparities in coronavirus disease-2019 (COVID-19) inc... more Background: Despite many studies reporting disparities in coronavirus disease-2019 (COVID-19) incidence and outcomes in Black and Hispanic/Latino populations, mechanisms are not fully understood to inform mitigation strategies. Objective: The aim was to test whether neighborhood factors beyond individual patient-level factors are associated with in-hospital mortality from COVID-19. We hypothesized that the Area Deprivation Index (ADI), a neighborhood census-block-level composite measure, was associated with COVID-19 mortality independently of race, ethnicity, and other patient factors. Research Design: Multicenter retrospective cohort study examining COVID-19 in-hospital mortality. Subjects: Inclusion required hospitalization with positive SARS-CoV-2 test or COVID-19 diagnosis at three large Midwestern academic centers. Measure(s): The primary study outcome was COVID-19 in-hospital mortality. Patient-level predictors included age, sex, race, insurance, body mass index, comorbidities, and ventilation. Neighborhoods were examined through the national ADI neighborhood deprivation rank comparing in-hospital mortality across ADI quintiles. Analyses used multivariable logistic regression with fixed site effects. Results: Among 5999 COVID-19 patients median age was 61 (interquartile range: 44–73), 48% were male, 30% Black, and 10.8% died. Among patients who died, 32% lived in the most disadvantaged quintile while 11% lived in the least disadvantaged quintile; 52% of Black, 24% of Hispanic/Latino, and 8.5% of White patients lived in the most disadvantaged neighborhoods. Living in the most disadvantaged neighborhood quintile predicted higher mortality (adjusted odds ratio: 1.74; 95% confidence interval: 1.13–2.67) independent of race. Age, male sex, Medicare coverage, and ventilation also predicted mortality. Conclusions: Neighborhood disadvantage independently predicted in-hospital COVID-19 mortality. Findings support calls to consider neighborhood measures for vaccine distribution and policies to mitigate disparities.
American journal of medical quality : the official journal of the American College of Medical Quality, 2017
Evaluation and payment for health plans and providers have been increasingly tied to their perfor... more Evaluation and payment for health plans and providers have been increasingly tied to their performance on quality metrics, which can be influenced by patient- and community-level sociodemographic factors. The aim of this study was to examine whether performance on Healthcare Effectiveness Data and Information Set (HEDIS) measures varied as a function of community sociodemographic characteristics at the primary care clinic level. Twenty-two primary care sites of a large multispecialty group practice were studied during the period of April 2013 to June 2016. Significant associations were found between sites' performance on selected HEDIS measures and their neighborhood sociodemographic characteristics. Outcome measures had stronger associations with sociodemographic factors than did process measures, with a range of significant correlation coefficients (absolute value, regardless of sign) from 0.44 to 0.72. Sociodemographic factors accounted for as much as 25% to 50% of the observ...
American journal of medical quality : the official journal of the American College of Medical Quality, 2016
A number of quality rating systems to rank health care providers have been developed over the yea... more A number of quality rating systems to rank health care providers have been developed over the years with the intention of helping consumers make informed health care purchasing decisions. Many use sets of individual quality measures to calculate a global rating. The utility of a global rating for consumer choice hinges on the relationships among included measures and the extent to which they jointly reflect an underlying dimension of quality. Publicly reported data on 4 quality domains-complication, mortality, readmission, and patient safety-from Centers for Medicare & Medicaid Services' Hospital Compare website were used to examine correlations among individual measures within each measure group (within-group correlations) and correlations between pairs of measures across different measure groups (between-group correlations). Modest within-group correlations were found in only 2 domains (mortality and readmission), and there were no meaningful between-group associations. These ...
Beginning January 1st, 2011 in the U.S. the Affordable Care Act enhanced Medicare coverage for pr... more Beginning January 1st, 2011 in the U.S. the Affordable Care Act enhanced Medicare coverage for preventive services by eliminating patient cost-sharing under Part B and by introducing an "Annual Wellness Visit," also free-of-charge. We evaluated the early effects of these reforms on utilization of preventive services. We analyzed nationally representative data on 15,044 Medicare seniors from the 2008-2010, and 2012 Medical Expenditure Panel Survey, and examined self-reported cholesterol test, blood pressure check, flu vaccination, endoscopy, fecal occult blood test, prostate specific antigen test, breast examination, and mammography. Enhanced Medicare benefits had no effects on preventive services utilization among Medicare seniors in 2012, including those with traditional Medicare and no other supplemental insurance, who stood to benefit the most from Part B enhancements. The muted overall response can be partly attributed to the fact that most seniors already held insuran...
Objectives:To systematically review the scientific evidence on efficacy, safety, and comparative ... more Objectives:To systematically review the scientific evidence on efficacy, safety, and comparative effectiveness of various types of bariatric surgery for treating adult patients with a body mass index (BMI) of 30.0 to 34.9 kg/m2 and diabetes or impaired glucose tolerance (IGT) and to compare effectiveness of surgery versus nonsurgical interventions in this population.
Using the Hospital Compare overall hospital quality star ratings and other publicly available dat... more Using the Hospital Compare overall hospital quality star ratings and other publicly available data on acute care hospitals, we examined star ratings for the flagship hospitals of a set of multihospital health systems in the United States. We compared star ratings and hospital characteristics of flagship and nonflagship hospitals across and within 113 health systems. The system flagship hospitals had significantly lower star ratings than did nonflagship hospitals, and they did not generally have the highest star ratings in their own systems. Higher teaching intensity, larger bed size, higher uncompensated care, and higher disproportionate share hospital (DSH) patient percentage were all significantly associated with lower star ratings of flagship hospitals when compared with nonflagship hospitals across all health systems; the flagship hospital of a system was more likely to have the lowest star rating in its system if the difference in DSH percentage was relatively large between the...
Cataracts account for about half of all cases of blindness worldwide, with the vast majority in d... more Cataracts account for about half of all cases of blindness worldwide, with the vast majority in developing countries, where blindness and visual impairment can reduce life expectancy and economic productivity. Most of these cases can be cured by quick, inexpensive surgical procedures, but a shortage of trained surgeons makes it unlikely that the need for such surgeries-estimated to reach 32 million cases globally by 2020-can be met under current practices. HelpMeSee Inc. (HMS) is developing an approach to surgery training and delivery that includes use of high-fidelity simulator technology and associated curricula for high-volume training, development of a system of independent private practitioners, and training where necessary of individuals without medical degrees. RAND researchers determined that the program has the potential to scale up surgical capacity rapidly and that under optimistic assumptions, the HMS program could largely close the backlog of surgical cases in the four ...
This systematic review sought to identify the best available evidence regarding strategies for al... more This systematic review sought to identify the best available evidence regarding strategies for allocating scarce resources during mass casualty events (MCEs). Specifically, the review addresses the following questions: (1) What strategies are available to policymakers to optimize the allocation of scarce resources during MCEs? (2) What strategies are available to providers to optimize the allocation of scarce resources during MCEs? (3) What are the public's key perceptions and concerns regarding the implementation of strategies to allocate scarce resources during MCEs? (4) What methods are available to engage providers in discussions regarding the development and implementation of strategies to allocate scarce resources during MCEs? We searched Medline, Scopus, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Global Health, Web of Science®, and the Cochrane Database of Systematic Reviews from 1990 through 2011. To identify relevant non-peer-reviewed rep...
Background: Despite many studies reporting disparities in coronavirus disease-2019 (COVID-19) inc... more Background: Despite many studies reporting disparities in coronavirus disease-2019 (COVID-19) incidence and outcomes in Black and Hispanic/Latino populations, mechanisms are not fully understood to inform mitigation strategies. Objective: The aim was to test whether neighborhood factors beyond individual patient-level factors are associated with in-hospital mortality from COVID-19. We hypothesized that the Area Deprivation Index (ADI), a neighborhood census-block-level composite measure, was associated with COVID-19 mortality independently of race, ethnicity, and other patient factors. Research Design: Multicenter retrospective cohort study examining COVID-19 in-hospital mortality. Subjects: Inclusion required hospitalization with positive SARS-CoV-2 test or COVID-19 diagnosis at three large Midwestern academic centers. Measure(s): The primary study outcome was COVID-19 in-hospital mortality. Patient-level predictors included age, sex, race, insurance, body mass index, comorbidities, and ventilation. Neighborhoods were examined through the national ADI neighborhood deprivation rank comparing in-hospital mortality across ADI quintiles. Analyses used multivariable logistic regression with fixed site effects. Results: Among 5999 COVID-19 patients median age was 61 (interquartile range: 44–73), 48% were male, 30% Black, and 10.8% died. Among patients who died, 32% lived in the most disadvantaged quintile while 11% lived in the least disadvantaged quintile; 52% of Black, 24% of Hispanic/Latino, and 8.5% of White patients lived in the most disadvantaged neighborhoods. Living in the most disadvantaged neighborhood quintile predicted higher mortality (adjusted odds ratio: 1.74; 95% confidence interval: 1.13–2.67) independent of race. Age, male sex, Medicare coverage, and ventilation also predicted mortality. Conclusions: Neighborhood disadvantage independently predicted in-hospital COVID-19 mortality. Findings support calls to consider neighborhood measures for vaccine distribution and policies to mitigate disparities.
American journal of medical quality : the official journal of the American College of Medical Quality, 2017
Evaluation and payment for health plans and providers have been increasingly tied to their perfor... more Evaluation and payment for health plans and providers have been increasingly tied to their performance on quality metrics, which can be influenced by patient- and community-level sociodemographic factors. The aim of this study was to examine whether performance on Healthcare Effectiveness Data and Information Set (HEDIS) measures varied as a function of community sociodemographic characteristics at the primary care clinic level. Twenty-two primary care sites of a large multispecialty group practice were studied during the period of April 2013 to June 2016. Significant associations were found between sites' performance on selected HEDIS measures and their neighborhood sociodemographic characteristics. Outcome measures had stronger associations with sociodemographic factors than did process measures, with a range of significant correlation coefficients (absolute value, regardless of sign) from 0.44 to 0.72. Sociodemographic factors accounted for as much as 25% to 50% of the observ...
Uploads
Papers by Jianhui Hu