Arlene S Ash
Datos Biográficos
| ID | 5534162 |
|---|---|
| NOMBRE | Arlene S Ash |
| NOMBRES | Arlene S |
| APELLIDO | Ash |
| FIRMA | ASH A S |
| AFILIACIONES | University of Massachusetts Chan Medical School |
| ORCID | 0000-0002-8448-0253 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 49 |
| TOTAL DE CITAS | 47 |
| TOTAL COMO AUTOR | 49 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1988 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2026 |
| ÍNDICE H | 2 |
Why patients stay in or leave a medically tailored meals program
Introduction: Medically tailored meals (MTMs) are home-delivered, nutritionally tailored meals designed for patients with complex or advanced diet-sensitive medical conditions and social stressors. Although MTM use can improve food security, diet quality, and health outcomes, and reduce overall healthcare use and cost, little is known about why patients enroll in, stay in, or withdraw from such programs. Methods: Between June 2023 and May 2024, w…
Days at Home for High-Need Medicare Patients
Facilitators and barriers to reach and enrollment into a medically tailored meals program within a section 1115 Medicaid pilot
Introduction: Medically tailored meals (MTMs) are home-delivered, nutritionally tailored meals for individuals living with complex or advanced diet-sensitive medical conditions. In 2020, Massachusetts Medicaid implemented the Flexible Services Program (FSP) through a Section 1115 Demonstration, which funded novel nutrition programs, including MTMs, for high-risk patients through Accountable Care Organizations (ACOs). Little is known from the prac…
A Novel Machine Learning Algorithm for Creating Risk-Adjusted Payment Formulas
In this study, by automating DXI clustering within clinically specified hierarchies, this algorithm built clinically interpretable risk models in large datasets while addressing diagnostic vagueness and gameability concerns
Predictive algorithm to stratify newborns at-risk for child undernutrition in India
Background: India is at the epicentre of global child undernutrition. Strategies to identify at-risk populations are needed in the context of limited resources. Methods: Data from children under the age of five surveyed in the 2015-2016 National Family Health Survey were used. Child undernutrition was assessed using anthropometric measurements. Predictor variables were identified from the extant literature and included if they could be measured a…
Development and Assessment of a New Framework for Disease Surveillance, Prediction, and Risk Adjustment
In this diagnostic modeling study, the new DXI classification system showed improved predictions over existing diagnostic classification systems for all spending and utilization outcomes considered
Predicting Adolescent Intervention Non-responsiveness for Precision HIV Prevention Using Machine Learning
Interventions to teach protective behaviors may be differentially effective within an adolescent population. Identifying the characteristics of youth who are less likely to respond to an intervention can guide program modifications to improve its effectiveness. Using comprehensive longitudinal data on adolescent risk behaviors, perceptions, sensation-seeking, peer and family influence, and neighborhood risk factors from 2564 grade 10-12 students …
Association of Social Determinants of Health With Adherence to Second-generation Antipsychotics for People With Bipolar Disorders in a Medicaid Population
Pollack, Jacqueline MSc; Dubare, Sonila MSPH, MA; Aduse-Poku, Livingstone MPH Author Information
Paper of Association of Social Determinants of Health With Adherence to Second-generation Antipsychotics for People With Bipolar Disorders in a Medicaid Population
Li, Nien Chen PhD, MPH, MA; Alcusky, Matthew PhD, PharmD; Masters, Grace A. MD; Ash, Arlene PhD Author Information
Complex Patients Have More Emergency Visits
IMPORTANCE: Better patient management can reduce emergency department (ED) use. Performance measures should reward plans for reducing utilization by predictably high-use patients, rather than rewarding plans that shun them. OBJECTIVE: The objective of this study was to develop a quality measure for ED use for people diagnosed with serious mental illness or substance use disorder, accounting for both medical and social determinants of health (SDH)…
Emergency Department and Primary Care Use in Massachusetts 5 Years After Health Reform
OBJECTIVE: Conceptually, access to primary care (through insurance) should reduce emergency department (ED) visits for primary care sensitive (PCS) conditions. We sought to identify characteristics of insured Massachusetts residents associated with PCS ED use, and compare such use for public versus private insurees. POPULATION AND SETTING: People under age 65 in the Massachusetts All-Payer Claims Data, 2011-2012. STUDY DESIGN: Retrospective, obse…
Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes
OBJECTIVE: To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS). METHODS: We studied 1481 patients hospitalized with acute coronary syndromes in Massachusetts and Georgia querying HRQoL via the ment…
Mispricing in the Medicare Advantage Risk Adjustment Model
The Centers for Medicare and Medicaid Services (CMS) implemented hierarchical condition category (HCC) models in 2004 to adjust payments to Medicare Advantage (MA) plans to reflect enrollees' expected health care costs. We use Verisk Health's diagnostic cost group (DxCG) Medicare models, refined "descendants" of the same HCC framework with 189 comprehensive clinical categories available to CMS in 2004, to reveal 2 mispricing errors resulting from…
Clinical Operations Variables are Associated With Blood Pressure Outcomes
BACKGROUND: Uncontrolled blood pressure (BP), among patients diagnosed and treated for the condition, remains an important clinical challenge; aspects of clinical operations could potentially be adjusted if they were associated with better outcomes. OBJECTIVES: To assess clinical operations factors' effects on normalization of uncontrolled BP. RESEARCH DESIGN: Observational cohort study. SUBJECTS: Patients diagnosed with hypertension from a large…
Bending the Cost Curve? Results From a Comprehensive Primary Care Payment Pilot
BACKGROUND: There is much interest in understanding how using bundled primary care payments to support a patient-centered medical home (PCMH) affects total medical costs. RESEARCH DESIGN AND SUBJECTS: We compare 2008-2010 claims and eligibility records on about 10,000 patients in practices transforming to a PCMH and receiving risk-adjusted base payments and bonuses, with similar data on approximately 200,000 patients of nontransformed practices r…
Elections 2012
Recent years have seen a wave of laws making it more difficult to vote in the United States. Their ostensible purpose is to prevent voting by persons not legally qualified, and thus to improve public confidence in electoral integrity. Are such laws in fact needed to address serious fraud problems? On the other hand, how many and what kinds of legitimate voters will be, or have been, disenfranchised by them? Is voter confidence positively, or nega…
Contraceptive Insurance Mandates
Shaffer, Ellen R. PhD, MPH; Sarfaty, Mona MD, MPH; Ash, Arlene S. PhD Author Information
Risk-adjusted Payment and Performance Assessment for Primary Care
BACKGROUND: Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. RESEARCH DESIGN: Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected pr…
Nursing Home Residence Confounds Gender Differences in Medicare Utilization
Research That Matters
From the Division of Biostatistics and Health Services Research, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA. Reprints: Bruce Barton, U Mass Medical School/QHS, 55 Lake Ave. N, Worcester, MA 01655
Measuring Quality
From the Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts. Contact: Arlene S. Ash, PhD, Health Care Research Unit, 801 Massachusetts Ave, 2nd floor, Boston, MA 02118. E-mail: [email protected]
Exploring the Determinants of Racial and Ethnic Disparities in Total Knee Arthroplasty
OBJECTIVE: To estimate national total knee arthroplasty (TKA) rates by economic factors, and the extent to which differences in insurance coverage, income, and assets contribute to racial and ethnic disparities in TKA use. DATA SOURCE: US longitudinal Health and Retirement Study survey data for the elderly and near-elderly (biennial rounds 1994-2004) from the Institute of Social Research, University of Michigan. STUDY DESIGN: The outcome is dicho…
Implications of Comorbidity on Costs for Patients With Alzheimer Disease
BACKGROUND: No prior studies have used a comprehensive clinical classification system to examine the effect of differences in overall illness burden and the presence of other diseases on costs for patients with Alzheimer disease (AD) when compared with demographically matched nondemented controls. STUDY DESIGN: Of a total of 627,775 enrollees who were eligible for medical and pharmacy benefits for 2003 and 2004 in the MarketScan Medicare Suppleme…
Predictors of Aggressive Therapy for Nonmetastatic Prostate Carcinoma in Massachusetts From 1998 to 2002
BACKGROUND: Most studies have found that black men are less likely to receive aggressive therapy for nonmetastatic prostate cancer, even after controlling for covariates. However, previous studies have not accounted for the clustering of outcomes by facility. OBJECTIVE: We sought to compare the proportions of black and white men receiving aggressive therapy for newly diagnosed nonmetastatic prostate cancer between 1998 and 2002, accounting for th…
Monitoring Depression Care
BACKGROUND: Linking process and outcomes is critical to accurately estimating healthcare quality and quantifying its benefits. OBJECTIVES: The objective of this study was to explore the relationship of guideline-based depression process measures with subsequent overall and psychiatric hospitalizations. RESEARCH DESIGN: This is a retrospective cohort study during which we used administrative and centralized pharmacy records for sample identificati…
Judging hospitals by severity-adjusted mortality rates
OBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated w…
Admission and mid-stay MedisGroups scores as predictors of death within 30 days of hospital admission
We examined the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict mortality 30 days following admission. MedisGroups measures severity both on admission and approximately one week into the hospital stay. The data base was a random sample of 20,985 admissions of Medicare beneficiaries with one of six conditions from 833 hospitals in seven states between January 1985 and May 1986. In al…
Elections 2012
Recent years have seen a wave of laws making it more difficult to vote in the United States. Their ostensible purpose is to prevent voting by persons not legally qualified, and thus to improve public confidence in electoral integrity. Are such laws in fact needed to address serious fraud problems? On the other hand, how many and what kinds of legitimate voters will be, or have been, disenfranchised by them? Is voter confidence positively, or nega…
Admission MedisGroups Score and the Cost of Hospitalizations
Concerns about the insensitivity of Medicare's diagnosis-related groups (DRGs) to illness severity heightened interest in the potential of alternative patient classification systems to improve the fairness of hospital reimbursement. This article examines the ability of admission MedisGroups score to explain the costs of hospital stays. The database contained 54,112 patients 65 years or older discharged in 28 high-frequency DRGs from 1984 to the m…
Measuring patients’ desire for autonomy
The Self-Adapting Focused Review System
Medical record review is increasing in importance as the need to identify and monitor utilization and quality of care problems grow. To conserve resources, reviews are usually performed on a subset of cases. If judgment is used to identify subgroups for review, this raises the following questions: How should subgroups be determined, particularly since the locus of problems can change over time? What standard of comparison should be used in interp…
Admission and mid-stay MedisGroups scores as predictors of death within 30 days of hospital admission
We examined the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict mortality 30 days following admission. MedisGroups measures severity both on admission and approximately one week into the hospital stay. The data base was a random sample of 20,985 admissions of Medicare beneficiaries with one of six conditions from 833 hospitals in seven states between January 1985 and May 1986. In al…
Admission and Mid-Stay MedisGroups?? Scores as Predictors of Hospitalization Charges
This study examines the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict hospitalization charges. MedisGroups measures severity both on admission and approximately 1 week into the hospital stay. The data base contained 23,361 admissions of Medicare beneficiaries in six conditions from 836 hospitals in seven states between January 1985, and May 1986. In all six conditions, higher admi…
Predicting In-Hospital Mortality
Hospital mortality statistics derived from administrative data may not adjust adequately for patient risk on admission. Using clinical data collected from the medical record, this study compared the ability of six models to predict in-hospital death, including one model based on administrative data (age, sex, and principal and secondary diagnoses), one on admission MedisGroups score, and one on an approximation of the Acute Physiology Score (APS)…
Postoperative Adverse Events of Common Surgical Procedures in the Medicare Population
Mortality rates are the most widely used measure in assessing patient outcome from hospitalization. However, they may be an insensitive measure of quality for surgical patients because death is a relatively rare outcome. A random sample of patient data (n = 8126) selected from the Medicare files of seven states was used to identify, through chart abstraction, clinical postoperative complications of surgery that could serve as measures of quality.…
Self-Report Versus Medical Record Functional Status
The importance of assessing functional status in the hospitalized patient is gaining recognition. However, the availability and accuracy of medical record functional status data are uncertain. We collected data on 2,504 patients greater than 65 years of age discharged alive. A personal interview conducted 2 days before discharge recorded the patient's self-reported ability to perform 5 activities of daily living scales. Medical record abstraction…
Medis Groups Data Bases
IEZZONI, LISA I. MD, MSC; HOTCHKIN, ELIZABETH K. BA; ASH, ARLENE S. PHD; SHWARTZ, MICHAEL PHD; MACKIERNAN, YEVGENIA BA Author Information
Small Area Variations in Hospitalization Rates
This research investigates the degree that estimates of the magnitude of small area variations in hospitalization rates depend on both the estimation method and the number of years of data used. Hospital discharge abstracts for patients 65 and older from acute care hospitals in Massachusetts from 1982 to 1987 were analyzed. The SCV statistic, the approach used in many current small area variation studies, and empirical Bayes (EB), an approach tha…
Judging hospitals by severity-adjusted mortality rates
OBJECTIVES: This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. METHODS: Data came from 100 acute care hospitals nationwide and 11880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated w…
The Importance of Comorbidities in Explaining Differences in Patient Costs
OBJECTIVES: The authors examine to what extent comorbidities contribute to differences in patient hospital costs. METHODS: The medical record data for this study were collected from 15 metropolitan Boston hospital for 4,439 patients admitted mostly in 1985 for one of eight common conditions. Massachusetts hospital discharge abstract data for 1985 and 1993 also were used. Comorbidities were identified from the medical record for the 15-hospital da…
Identifying Poor-Quality Hospitals with Mortality Rates
Severity Measurement Methods and Judging Hospital Death Rates for Pneumonia
Payers and policymakers are increasingly examining hospital mortality rates as indicators of hospital quality. To be meaningful, these death rates must be adjusted for patient severity. This research examined whether judgments about an individual hospital's risk-adjusted mortality is affected by the severity adjustment method. Data came from 105 acute care hospitals nationwide that use the Medis-Groups severity measure. The study population was 1…
Variations in the Performance of Hip Fracture Procedures
OBJECTIVES: Hip replacement is the preferred treatment for displaced femoral neck fractures, whereas other less expensive procedures are preferred for nondisplaced fractures. The authors determined whether there was geographic variation in the use of hip replacement to treat displaced and nondisplaced fractures. METHODS: The authors studied 332 patients, age 65 years or older, hospitalized with a femoral neck fracture in three cities. RESULTS: Th…
Outcomes of Hypertension Care
Berlowitz, Dan R. MD, MPH; Ash, Arlene S. PhD; Hickey, Elaine C. RN, MS; Friedman, Robert H. MD; Kader, Boris PhD; Moskowitz, Mark A. MD Author Information
Profiling Outcomes of Ambulatory Care
OBJECTIVES: The authors explored the role of casemix adjustment when profiling outcomes of ambulatory care. METHODS: The authors reviewed the medical records of 656 patients with hypertension, diabetes, or chronic obstructive pulmonary disease (COPD) receiving care at one of three Department of Veterans Affairs medical centers. Outcomes included measures of physiological control for hypertension and diabetes, and of exacerbations for COPD. Predic…
Predicting In-Hospital Deaths from Coronary Artery Bypass Graft Surgery
OBJECTIVES: Severity-adjusted death rates for coronary artery bypass graft (CABG) surgery by provider are published throughout the country. Whether five severity measures rated severity differently for identical patients was examined in this study. METHODS: Two severity measures rate patients using clinical data taken from the first two hospital days (MedisGroups, physiology scores); three use diagnoses and other information coded on standard, co…
Reducing Random Variation in Reported Rates of Pressure Ulcer Development
OBJECTIVES: The authors evaluated methods of reporting on rates of pressure ulcer development in long-term care to identify approaches that lead to more stable estimates of actual performance. METHODS: Performance measures for facilities that adequately adjust for both random variation and casemix should be relatively stable from one time period to the next. The authors calculated facility rates of pressure ulcer development over eight consecutiv…
Methods for Analyzing Health Care Utilization and Costs
Important questions about health care are often addressed by studying health care utilization. Utilization data have several characteristics that make them a challenge to analyze. In this paper we discuss sources of information, the statistical properties of utilization data, common analytic methods including the two-part model, and some newly available statistical methods including the generalized linear model. We also address issues of study de…
Do Hip Replacements Improve Outcomes for Hip Fracture Patients
BACKGROUND: Hip fracture is a common problem among older Americans. Two types of procedures are available for repairing hip fractures: hip replacement and open or closed reduction with or without internal fixation. The assumption has been that hip replacement produces better functional outcomes. Although that is the common wisdom, outcome studies evaluating hip replacement for treatment of hip fracture are few and have not clearly documented its …
Does Diagnostic Information Contribute to Predicting Functional Decline in Long-Term Care
BACKGROUND: Compared with the acute-care setting, use of risk-adjusted outcomes in long-term care is relatively new. With the recent development of administrative databases in long-term care, such uses are likely to increase. OBJECTIVES: The objective of this study was to determine the contribution of ICD-9-CM diagnosis codes from administrative data in predicting functional decline in long-term care. RESEARCH DESIGN: We used a retrospective samp…
Does More “Appropriateness” Explain Higher Rates of Cardiac Procedures Among Patients Hospitalized With Coronary Heart Disease
BACKGROUND: There have been few studies of the extent to which differences in the pool of patients being managed might account for geographic variations in treatment rates. OBJECTIVE: For two cardiac procedures, cardiac catheterization and revascularization, we evaluate the hypothesis that differences in "the percentage of patients for whom the procedure is appropriate" is a factor explaining variations in use rates among those hospitalized with …
Measuring the Quality of Depression Care in a Large Integrated Health System
BACKGROUND: Guideline-based depression process measures provide a powerful way to monitor depression care and target areas needing improvement. OBJECTIVES: To assess the adequacy of depression care in the Veterans Health Administration (VHA) using guideline-based process measures derived from administrative and centralized pharmacy records, and to identify patient and provider characteristics associated with adequate depression care. RESEARCH DES…
Monitoring Depression Care
BACKGROUND: Linking process and outcomes is critical to accurately estimating healthcare quality and quantifying its benefits. OBJECTIVES: The objective of this study was to explore the relationship of guideline-based depression process measures with subsequent overall and psychiatric hospitalizations. RESEARCH DESIGN: This is a retrospective cohort study during which we used administrative and centralized pharmacy records for sample identificati…
Medicine (45 obras) · Internal Medicine (22 obras) · Internal Medicine (22 obras) · Healthcare Policy and Management (19 obras) · Primary Care and Health Outcomes (17 obras) · Emergency Medicine (15 obras) · Emergency Medicine (15 obras) · Health care (15 obras) · Family medicine (14 obras) · Demography (9 obras)