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541 results on '"Regenbogen, Scott E."'

9. Impact of Medicare eligibility on informal caregiving for surgery and stroke

Author

Roo, Ana C. De, Ha, Jinkyung, Regenbogen, Scott E., and Hoffman, Geoffrey J.

Subjects
Medical research, Medicine, Experimental, Medicare -- Research, Caregivers -- Research, Postoperative care -- Research, Business, Health care industry
Abstract

Objective: To assess whether the intensity of family and friend care changes after older individuals enroll in Medicare at age 65. Data Sources: Health and Retirement Study survey data (1998-2018). Study Design: We compared informal care received by patients hospitalized for stroke, heart surgery, or joint surgery and who were stratified into propensityweighted pre- and post-Medicare eligibility cohorts. A regression discontinuity design compared the self-reported likelihood of any care receipt, weekly hours of overall informal care, and intensity of informal care (hours among those receiving any care) at Medicare eligibility. Data Collection: Not applicable. Principal Findings: A total of 2270 individuals were included; 1674 (73.7%) stroke, 240 (10.6%) heart surgery, and 356 (15.7%) joint surgery patients. Mean (SD) care received was 20.0 (42.1) weekly hours. Of the 1214 (53.5%) patients who received informal care, the mean (SD) care receipt was 37.4 (51.7) weekly hours. Mean (SD) overall weekly care received was 23.4 (45.5), 13.9 (35.8), and 7.8 (21.6) for stroke, heart surgery, and joint surgery patients, respectively. The onset of Medicare eligibility was associated with a 13.6 percentage-point decrease in the probability of informal care received for stroke patients (p = 0.003) but not in the other acute care cohorts. Men had a 16.8 percentage-point decrease (p = 0.002) in the probability of any care receipt. Conclusions: Medicare coverage was associated with a substantial decrease in family and friend caregiving use for stroke patients. Informal care may substitute for rather than complement restorative care, given that Medicare is known to expand the use of postacute care. The observed spillover effect of Medicare coverage on informal caregiving has implications for patient function and caregiver burden and should be considered in episode-based reimbursement models that alter professional rehabilitative care intensity. KEYWORDS caregiving, discontinuity, Medicare, stroke, surgery What is known * Family and friend care is received by millions of older Americans * Medicare spends $124 billion on surgical care, $30 billion on stroke care, and is known to increase the use of postacute services for new enrollees * Informal care can substitute for maintenance and well-being assistance requiring less skilled support What this study adds * Older Medicare beneficiaries receive substantial family and friend caregiving after acute health events * Medicare eligibility is associated with decreased informal caregiving use for those who experience a stroke * Ongoing restorative services for stroke patients may decrease the need for complementary support from family and friends, 1 | INTRODUCTION Each year, Medicare spends approximately $124 billion on surgical care, $30 billion on stroke care, and $60 billion on posthospital care. (1-4) It is well recognized that [...]

Published
2023
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10. Anorectal Physiology

Author

Suwanabol, Pasithorn A., Regenbogen, Scott E., Steele, Scott R., editor, Hull, Tracy L., editor, Hyman, Neil, editor, Maykel, Justin A., editor, Read, Thomas E., editor, and Whitlow, Charles B., editor

Published
2022
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12. Coordination of Care Around Surgery for Colon Cancer: Insights From National Patterns of Physician Encounters With Medicare Beneficiaries

Author

Lin, Sunny C, Regenbogen, Scott E, Hollingsworth, John M, Funk, Russell, and Adler-Milstein, Julia

Subjects
Health Services, Clinical Research, Cancer, Digestive Diseases, Colo-Rectal Cancer, Patient Safety, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Colonic Neoplasms, Health Personnel, Hospitals, Humans, Medicare, Models, Theoretical, Outcome Assessment, Health Care, Patient Care, Patient Care Management, Practice Patterns, Physicians', Surveys and Questionnaires, United States
Abstract

PURPOSE:To improve care coordination for complex cancers, it is critical to establish a more nuanced understanding of the types of providers involved. As the number of provider types increases, strategies to support cancer care coordination must adapt to a greater variety of information needs, communication styles, and treatment strategies. METHODS:We categorized providers into 11 types, using National Provider Identifier specialties. Using Medicare claims, we counted the number of unique combinations of provider types billed during preoperative, operative, and postdischarge care for colon cancer surgery and assessed how this count varies across hospitals. The study included 70,567 beneficiaries in fee-for-service Medicare A and B for 6 months before and 60 days after an admission for colectomy for colon cancer between 2008 and 2011. RESULTS:We observed 1,554 preoperative provider-type combinations, 975 operative combinations, and 1,571 postdischarge combinations. The three most common combinations in the preoperative phase were general medicine only, other medical specialists only, and general medicine and other medical specialists. In the operative phase, the three most common combinations were primary surgery, anesthesiology, and pathology; general medicine, other medical specialists, radiology, primary surgery, anesthesiology, and pathology; and other medical specialists, radiology, primary surgery, anesthesiology, and pathology. In the postdischarge phase, the three most common combinations were general medicine, general medicine and other medical specialists, and general medicine and oncology. On average, each hospital had 15 preoperative, 11 operative, and 15 postoperative combinations. High-volume, larger, teaching, urban, and noncritical access hospitals had more combinations in all phases. CONCLUSION:Many provider-type combinations are involved in colon cancer surgery care. Substantial variation exists across hospitals types, suggesting that certain hospitals need additional resources and more flexible infrastructure to coordinate care.

Published
2019

14. Hospital Strategies in Commercial Episode-Based Reimbursement.

Author

Regenbogen, Scott E., Cocroft, Shelytia, Krein, Sarah L., and Thompson, Michael P.

Subjects
*HEALTH insurance reimbursement, *QUALITATIVE research, *INTERPROFESSIONAL relations, *COST analysis, *INTERVIEWING, *LEADERSHIP, *HEALTH insurance, *JUDGMENT sampling, *THEMATIC analysis, *RESEARCH methodology, *HOSPITAL health promotion programs, *QUALITY assurance
Abstract

OBJECTIVES: To understand hospitals' approaches to spending reduction in commercial episode-based payment programs and inform incentive design. STUDY DESIGN: Qualitative arm of an explanatory sequential mixed-methods study involving semistructured interviews with hospital leaders participating in a statewide quality improvement collaborative with novel episode-based incentive payments introduced by the state's largest commercial payer. METHODS: We recruited 21 leaders from 8 purposively selected, diverse hospitals with both high and low performance. Video teleconference--based interviews followed a standardized protocol and addressed 4 domains: choice of clinical condition for evaluation, strategies for episode spending reduction, best practices for success in earning incentives, and barriers to achievement. Rapid qualitative analysis with purposeful data reduction was employed to generate a matrix of key themes within the study domains. RESULTS: Strategies were similar between high- and low-performing hospitals. When selecting conditions, some hospitals focused on areas of underperformance, aiming for improvement opportunities, whereas others chose conditions already achieving highest efficiency. Many tried to synergize with other ongoing improvement initiatives and clinical areas with established leaders and champions. Key strategies included data-driven improvement, care standardization, and protocol dissemination. Best practices for success included readmission prevention and postacute care spending containment. CONCLUSIONS: The findings highlighted hospitals' most common strategies and approaches, providing several insights into optimal design of commercial episode-based incentives: They must be lucrative enough to earn attention or consistent with larger federal programs; hospitals need opportunities to succeed through both improved performance and sustained excellence; and programs may incur malalignment between hospitals and credentialed physicians. [ABSTRACT FROM AUTHOR]

Published
2024
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16. Outcomes of Surgery in Older Adults

Author

Lightner, Amy, Regenbogen, Scott E., Etzioni, David A., Finlayson, Emily, Section editor, Rosenthal, Ronnie A., editor, Zenilman, Michael E., editor, and Katlic, Mark R., editor

Published
2020
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35. The Specific Aims Page: A Primer

Author

Roberson, Jeffrey L., primary, Maguire, Lillias H., additional, Mitchem, John B., additional, Regenbogen, Scott E., additional, Smith, J. Joshua, additional, and Huang, Emina, additional

Published
2023
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36. Association of transanal minimally invasive surgical approach with oncologic outcomes over conventional transanal excision for early-stage rectal cancer: An analysis of the US Rectal Cancer Consortium.

Author

Warren, Emilie, primary, Gamboa, Adriana C., additional, Medin, Caroline, additional, Hendren, Samantha, additional, Regenbogen, Scott E., additional, Holder-Murray, Jennifer, additional, Kalady, Matthew, additional, Ejaz, Aslam, additional, Hawkins, Alexander, additional, Wise, Paul, additional, Silviera, Matthew, additional, Maithel, Shishir K., additional, and Balch, Glen C., additional

Published
2023
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37. Neoadjuvant chemoradiation does not improve outcomes for patients undergoing resection for upper rectal cancer: A US Rectal Cancer Consortium analysis.

Author

Medin, Caroline, primary, Gamboa, Adriana C., additional, Warren, Emilie, additional, Regenbogen, Scott E., additional, Hendren, Samantha, additional, Holder-Murray, Jennifer, additional, Kalady, Matthew, additional, Ejaz, Aslam, additional, Hawkins, Alexander, additional, Silviera, Matthew, additional, Maithel, Shishir K., additional, and Balch, Glen C., additional

Published
2023
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46. High Complication Rate After Early Ileostomy Closure: Early Termination of the Short Versus Long Interval to Loop Ileostomy Reversal After Pouch Surgery Randomized Trial

Author

Vogel, Jon D., primary, Fleshner, Phillip R., additional, Holubar, Stefan D., additional, Poylin, Vitaliy Y., additional, Regenbogen, Scott E., additional, Chapman, Brandon C., additional, Messaris, Evangelos, additional, Mutch, Matthew G., additional, and Hyman, Neil H., additional

Published
2023
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