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Medicare Advantage plans have incentives and tools to optimize patient care. Therefore, Medicare Advantage hospitalizations may have lower cost and higher quality than similar traditional Medicare hospitalizations. We applied a coarsened matching approach to 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. We found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays. We found little difference in the cost and length of medical stays and in readmission rates. One explanation is that Medicare Advantage plans use outpatient settings for many patients with behavioral health conditions and for injury and surgical patients with less complex health needs. Alternatively, the observed differences in behavioral health cost and length of stay may represent skimping on appropriate care.

Background: Active surveillance (AS) has been widely implemented within Veterans Affairs' medical centers (VAMCs) as a standard of care for low-risk prostate cancer (PCa). Patient characteristics such as age, race, and Agent Orange (AO) exposure may influence advisability of AS in veterans. The 17-gene assay may improve risk stratification and management selection., Objectives: To compare management strategies for PCa at 6 VAMCs before and after introduction of the Oncotype DX Genomic Prostate Score (GPS) assay., Study Design: We reviewed records of patients diagnosed with PCa between 2013 and 2014 to identify management patterns in an untested cohort. From 2015 to 2016, these patients received GPS testing in a prospective study. Charts from 6 months post biopsy were reviewed for both cohorts to compare management received in the untested and tested cohorts., Subjects: Men who just received their diagnosis and have National Comprehensive Cancer Network (NCCN) very low-, low-, and select cases of intermediate-risk PCa., Results: Patient characteristics were generally similar in the untested and tested cohorts. AS utilization was 12% higher in the tested cohort compared with the untested cohort. In men younger than 60 years, utilization of AS in tested men was 33% higher than in untested men. AS in tested men was higher across all NCCN risk groups and races, particular in low-risk men (72% vs 90% for untested vs tested, respectively). Tested veterans exposed to AO received less AS than untested veterans. Tested nonexposed veterans received 19% more AS than untested veterans. Median GPS results did not significantly differ as a factor of race or AO exposure., Conclusions: Men who receive GPS testing are more likely to utilize AS within the year post diagnosis, regardless of age, race, and NCCN risk group. Median GPS was similar across racial groups and AO exposure groups, suggesting similar biology across these groups. The GPS assay may be a useful tool to refine risk assessment of PCa and increase rates of AS among clinically and biologically low-risk patients, which is in line with guideline-based care.

Objectives: Although male height is positively associated with many aspects of mate quality, average height men attain higher reproductive success in US populations. We hypothesize that this is because the advantages associated with taller stature accrue mainly from not being short, rather than from being taller than average. Lower fertility by short men may be a consequence of their and their partner's lower scores on aspects of mate quality. Taller men, although they score higher on mate quality compared to average height men, may have lower fertility because they are more likely to be paired with taller women, who are potentially less fertile., Methods: We analyzed data from The Integrated Health Interview Series (IHIS) of the United States (N = 165,606). Segmented regression was used to examine patterns across the height continuum., Results: On all aspects of own and partner quality, shorter men scored lower than both average height and taller men. Height more strongly predicted these aspects when moving from short to average height, than when moving from average to taller heights. Women of a given height who scored lower on mate quality also had shorter partners., Conclusions: Shorter men faced a double disadvantage with respect to both their own mate quality and that of their spouses. Scores of taller men were only marginally higher than those of average height men, suggesting that being tall is less important than not being short. Although effect sizes were small, our results may partly explain why shorter and taller men have lower fertility than those of average stature., (Copyright © 2014 Wiley Periodicals, Inc.)

Background: Patient satisfaction is an important component used to assess quality of health care. Limited access to and choice of physicians, perception of receiving second-class care by recipients, and possible negative caregiver attitudes could cause Medicaid enrollees to be less satisfied with their physicians than other patients., Methods: A cross-sectional survey was conducted of 603 patients visiting four family practice residency clinics during a 1-week period that yielded a 72% response or 436 usable surveys. The 39-item survey included basic demographics (age, gender, site, and first-time visit status), five of Ware's "dimensions" of patient satisfaction, a composite score for life satisfaction, a measure of patient confidence in the local medical care community, and questions about how patients felt they were treated, based on insurance type. It was hypothesized that Medicaid enrollees would not be as satisfied with their care as other patients., Results: The study hypothesis was rejected after using two-sample t tests and regression analyses. Lower levels of patient satisfaction were not found in Medicaid enrollees, even after adjusting for the effects of differing demographic characteristics, possible different life satisfaction levels, and possible different levels of confidence in the local medical care community., Conclusions: The results of this study show that enrollment in Medicaid did not result in lower levels of patient satisfaction. Future research about these issues in settings other than family practice residency clinics is needed.