William H Shrank
Dados Biográficos
| ID | 5133772 |
|---|---|
| NOME | William H Shrank |
| PRENOMES | William H |
| SOBRENOME | Shrank |
| ASSINATURA | SHRANK W H |
| AFILIAÇÕES | Brigham and Women's Hospital |
| VERIFICADO | Não |
| TOTAL DE OBRAS | 23 |
| TOTAL DE CITAÇÕES | 0 |
| TOTAL COMO AUTOR | 23 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2006 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2025 |
| ÍNDICE H | 0 |
Artificial Intelligence and Health Care Waste—Promise or Peril
This Viewpoint explores the opportunities and risks posed by AI in the health care system through the lens of the National Academy of Medicine’s framework of health care waste
Association Between Community-Level Social Risk and Spending Among Medicare Beneficiaries
In this cross-sectional study of Medicare beneficiaries, the ADI explained little variation in health care spending, was negatively correlated with spending conditional on demographic and clinical characteristics, and was poorly correlated with self-reported social risk factors. This prompts caution and nuance when using community-level measures of social risk such as the ADI for social risk adjustment within Medicare value-based payment programs
Association Between a Bundled Payment Program for Lower Extremity Joint Replacement and Patient Outcomes Among Medicare Advantage Beneficiaries
In this study of an LEJR bundled payment program offered by a national Medicare Advantage insurer, findings suggest that physician practice participation in the program was associated with a decrease in episode spending without changes in quality. Bundled payments offered by private insurers, including Medicare Advantage plans, are an alternate payment option to fee for service that may reduce spending for LEJR episodes while maintaining quality …
Comparison of Health Care Utilization by Medicare Advantage and Traditional Medicare Beneficiaries With Complex Care Needs
In this cross-sectional study of Medicare beneficiaries with complex care needs, those enrolled in MA had lower rates of hospital stays, ED visits, and 30-day readmissions than similar beneficiaries enrolled in TM, suggesting that managed care activities in MA may influence the nature and quality of care provided to these beneficiaries
Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries
In this cross-sectional study of Medicare beneficiaries, those enrolled in MA had lower rates of low-value care than those enrolled in TM; elements of insurance design present in the MA program and absent in TM were associated with reduction in low-value care
Association Between Self-reported Health-Related Social Needs and Acute Care Utilization Among Older Adults Enrolled in Medicare Advantage
In this cross-sectional study of older adults enrolled in Medicare Advantage, self-reported HRSNs were common and associated with statistically significantly increased rates of acute care utilization, with variation in which HRSNs were associated with different utilization measures. These findings provide evidence of the unique association between certain HRSNs and different types of acute care utilization, which could help refine the development…
A Private-Sector Partnership to Promote Equitable Vaccine Delivery
The COVID-19 pandemic has laid bare deep, extensive, and intractable racial/ethnic disparities in the health care system. Compared with White individuals in the US, Black and Hispanic individuals have been 30% and 69% more likely, respectively, to contract COVID-19, and 42% and 22% more likely to die from the disease. Black and Hispanic individuals in the US have been 2 to 3 times more likely to experience economic hardship during the pandemic. 2…
Costly New Alzheimer Disease Medications on the Horizon—Financing Alternatives for Medicare
Sungchul Park, PhD; Lindsay White, PhD; Paul Fishman, PhD; Eric B. Larson, MD, MPH; Norma B. Coe, PhD
Waste in the US Health Care System
Importance: The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health care spending may be considered waste. Despite efforts to reduce overtreatment, improve care, and address overpayment, it is likely that substantial waste in US health care spending remains. Objectives: To estimate current levels of waste in the US…
How Much Does Medication Nonadherence Cost the Medicare Fee-for-Service Program
BACKGROUND: Medication adherence is associated with lower health care utilization and savings in specific patient populations; however, few empirical estimates exist at the population level. OBJECTIVE: The main objective of this study was to apply a data-driven approach to obtain population-level estimates of the impact of medication nonadherence among Medicare beneficiaries with chronic conditions. RESEARCH DESIGN: Medicare fee-for-service (FFS)…
Longitudinal Patterns of Spending Enhance the Ability to Predict Costly Patients
BACKGROUND: With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. OBJECTIVES: To classify patients by their spending patterns ov…
Equity in the Receipt of Oseltamivir in the United States During the H1N1 Pandemic
Objectives. We assessed the relationship between individual characteristics and receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic and other flu seasons. Methods. In a cohort of individuals enrolled in pharmacy benefit plans, we used a multivariate logistic regression model to measure associations between subscriber characteristics and filling a prescription for oseltamivir during 3 flu seasons (October 2006–May 2007, …
Pharmacy-based Interventions to Reduce Primary Medication Nonadherence to Cardiovascular Medications
BACKGROUND: Primary medication nonadherence (PMN) occurs when patients do not fill new prescriptions. Interventions to reduce PMN have not been well described. OBJECTIVES: To determine whether 2 pharmacy-based interventions could decrease PMN. DESIGN: Two sequential interventions with a control group were evaluated after completion. The automated intervention began in 2007 and consisted of phone calls to patients on the third and seventh days aft…
Did Hedis Get it Right? Evaluating the Quality of a Quality Measure
BACKGROUND: As an example of the process that could be used to evaluate and optimize the performance of quality measures in routine practice, we evaluated whether the Healthcare Effectiveness Data and Information Set (HEDIS) measure assessing the "persistence of β-blocker treatment after a heart attack" correlates with post-myocardial infarction (MI) outcomes and whether or not there are alternative specifications of this construct which are bett…
Group-based Trajectory Models
BACKGROUND: Classifying medication adherence is important for efficiently targeting adherence improvement interventions. The purpose of this study was to evaluate the use of a novel method, group-based trajectory models, for classifying patients by their long-term adherence. RESEARCH DESIGN: We identified patients who initiated a statin between June 1, 2006 and May 30, 2007 in prescription claims from CVS Caremark and evaluated adherence over the…
Warnings Without Guidance
BACKGROUND: In January 2008, the Food and Drug Administration (FDA) communicated concerns about the efficacy of ezetimibe, but did not provide clear clinical guidance, and substantial media attention ensued. We investigated the proportion of patients who discontinued therapy and switched to a clinically appropriate alternative after the FDA communication. METHODS: Using claims data from a national pharmacy benefits manager, we created a rolling c…
Online Social Networking by Patients with Diabetes
Effect of Standardized, Patient-Centered Label Instructions to Improve Comprehension of Prescription Drug Use
OBJECTIVE: To evaluate the effectiveness of standardized, patient-centered label (PCL) instructions to improve comprehension of prescription drug use compared with typical instructions. METHODS: A total of 500 adult patients recruited from 2 academic and 2 community primary care clinics in Chicago, IL and Shreveport, LA were assigned to receive as follows: (1) standard prescription instructions written as times per day (once, twice 3 times per da…
Patient, Physician, and Payment Predictors of Statin Adherence
BACKGROUND: Although many patient, physician, and payment predictors of adherence have been described, knowledge of their relative strength and overall ability to explain adherence is limited. OBJECTIVES: To measure the contributions of patient, physician, and payment predictors in explaining adherence to statins. RESEARCH DESIGN: Retrospective cohort study using administrative data. SUBJECTS: A total of 14,257 patients insured by Horizon Blue Cr…
An Evaluation of the Relationship Between the Implementation of a Newly Designed Prescription Drug Label at Target Pharmacies and Health Outcomes
BACKGROUND: Medication errors represent a major public health concern, and inadequate prescription drug labels have been identified as a root cause of errors. A new prescription medication labeling system was implemented by Target pharmacies in May 2005 and aimed to improve health outcomes. OBJECTIVES: To evaluate whether the new Target label influenced patient health services utilization. SUBJECTS: Derived from 2 large health plans. RESEARCH DES…
Variability in Pharmacy Interpretations of Physician Prescriptions
BACKGROUND: The clarity of prescription drug instructions is a health literacy and medication safety concern. OBJECTIVE: To assess the variability of pharmacy interpretations of physician prescriptions. DESIGN: Identically written prescriptions for 4 common medications (atorvastatin, alendronate, trimethoprim/sulfamethoxazole, ibuprofen) were filled in 6 pharmacies (2 largest chains, 2 grocery stores, 2 independents) in 4 cities (Boston, Chicago,…
Is There a Relationship Between Patient Beliefs or Communication About Generic Drugs and Medication Utilization
BACKGROUND: Insurers and policymakers strive to stimulate more cost-effective prescribing and, increasingly, are educating beneficiaries about generics. OBJECTIVES: To evaluate the relationship between patient beliefs and communication about generic drugs and actual drug use. RESEARCH DESIGN AND SUBJECTS: We performed a national mailed survey of a random sample of 2500 commercially-insured adults. Patient responses were linked to pharmacy claims …
The Quality of Pharmacologic Care for Adults in the United States
BACKGROUND: Despite rising annual expenditures for prescription drugs, little systematic information is available concerning the quality of pharmacologic care for adults in the United States. We evaluated how frequently appropriate pharmacologic care is ordered in a national sample of U.S. residents. METHODS: The RAND/UCLA Modified Delphi process was used to select quality-of-care indicators for adults across 30 chronic and acute conditions and p…
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The Quality of Pharmacologic Care for Adults in the United States
BACKGROUND: Despite rising annual expenditures for prescription drugs, little systematic information is available concerning the quality of pharmacologic care for adults in the United States. We evaluated how frequently appropriate pharmacologic care is ordered in a national sample of U.S. residents. METHODS: The RAND/UCLA Modified Delphi process was used to select quality-of-care indicators for adults across 30 chronic and acute conditions and p…
An Evaluation of the Relationship Between the Implementation of a Newly Designed Prescription Drug Label at Target Pharmacies and Health Outcomes
BACKGROUND: Medication errors represent a major public health concern, and inadequate prescription drug labels have been identified as a root cause of errors. A new prescription medication labeling system was implemented by Target pharmacies in May 2005 and aimed to improve health outcomes. OBJECTIVES: To evaluate whether the new Target label influenced patient health services utilization. SUBJECTS: Derived from 2 large health plans. RESEARCH DES…
Variability in Pharmacy Interpretations of Physician Prescriptions
BACKGROUND: The clarity of prescription drug instructions is a health literacy and medication safety concern. OBJECTIVE: To assess the variability of pharmacy interpretations of physician prescriptions. DESIGN: Identically written prescriptions for 4 common medications (atorvastatin, alendronate, trimethoprim/sulfamethoxazole, ibuprofen) were filled in 6 pharmacies (2 largest chains, 2 grocery stores, 2 independents) in 4 cities (Boston, Chicago,…
Is There a Relationship Between Patient Beliefs or Communication About Generic Drugs and Medication Utilization
BACKGROUND: Insurers and policymakers strive to stimulate more cost-effective prescribing and, increasingly, are educating beneficiaries about generics. OBJECTIVES: To evaluate the relationship between patient beliefs and communication about generic drugs and actual drug use. RESEARCH DESIGN AND SUBJECTS: We performed a national mailed survey of a random sample of 2500 commercially-insured adults. Patient responses were linked to pharmacy claims …
Patient, Physician, and Payment Predictors of Statin Adherence
BACKGROUND: Although many patient, physician, and payment predictors of adherence have been described, knowledge of their relative strength and overall ability to explain adherence is limited. OBJECTIVES: To measure the contributions of patient, physician, and payment predictors in explaining adherence to statins. RESEARCH DESIGN: Retrospective cohort study using administrative data. SUBJECTS: A total of 14,257 patients insured by Horizon Blue Cr…
Online Social Networking by Patients with Diabetes
Effect of Standardized, Patient-Centered Label Instructions to Improve Comprehension of Prescription Drug Use
OBJECTIVE: To evaluate the effectiveness of standardized, patient-centered label (PCL) instructions to improve comprehension of prescription drug use compared with typical instructions. METHODS: A total of 500 adult patients recruited from 2 academic and 2 community primary care clinics in Chicago, IL and Shreveport, LA were assigned to receive as follows: (1) standard prescription instructions written as times per day (once, twice 3 times per da…
Warnings Without Guidance
BACKGROUND: In January 2008, the Food and Drug Administration (FDA) communicated concerns about the efficacy of ezetimibe, but did not provide clear clinical guidance, and substantial media attention ensued. We investigated the proportion of patients who discontinued therapy and switched to a clinically appropriate alternative after the FDA communication. METHODS: Using claims data from a national pharmacy benefits manager, we created a rolling c…
Group-based Trajectory Models
BACKGROUND: Classifying medication adherence is important for efficiently targeting adherence improvement interventions. The purpose of this study was to evaluate the use of a novel method, group-based trajectory models, for classifying patients by their long-term adherence. RESEARCH DESIGN: We identified patients who initiated a statin between June 1, 2006 and May 30, 2007 in prescription claims from CVS Caremark and evaluated adherence over the…
Equity in the Receipt of Oseltamivir in the United States During the H1N1 Pandemic
Objectives. We assessed the relationship between individual characteristics and receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic and other flu seasons. Methods. In a cohort of individuals enrolled in pharmacy benefit plans, we used a multivariate logistic regression model to measure associations between subscriber characteristics and filling a prescription for oseltamivir during 3 flu seasons (October 2006–May 2007, …
Pharmacy-based Interventions to Reduce Primary Medication Nonadherence to Cardiovascular Medications
BACKGROUND: Primary medication nonadherence (PMN) occurs when patients do not fill new prescriptions. Interventions to reduce PMN have not been well described. OBJECTIVES: To determine whether 2 pharmacy-based interventions could decrease PMN. DESIGN: Two sequential interventions with a control group were evaluated after completion. The automated intervention began in 2007 and consisted of phone calls to patients on the third and seventh days aft…
Did Hedis Get it Right? Evaluating the Quality of a Quality Measure
BACKGROUND: As an example of the process that could be used to evaluate and optimize the performance of quality measures in routine practice, we evaluated whether the Healthcare Effectiveness Data and Information Set (HEDIS) measure assessing the "persistence of β-blocker treatment after a heart attack" correlates with post-myocardial infarction (MI) outcomes and whether or not there are alternative specifications of this construct which are bett…
Longitudinal Patterns of Spending Enhance the Ability to Predict Costly Patients
BACKGROUND: With rising health spending, predicting costs is essential to identify patients for interventions. Many of the existing approaches have moderate predictive ability, which may result, in part, from not considering potentially meaningful changes in spending over time. Group-based trajectory modeling could be used to classify patients into dynamic long-term spending patterns. OBJECTIVES: To classify patients by their spending patterns ov…
Waste in the US Health Care System
Importance: The United States spends more on health care than any other country, with costs approaching 18% of the gross domestic product (GDP). Prior studies estimated that approximately 30% of health care spending may be considered waste. Despite efforts to reduce overtreatment, improve care, and address overpayment, it is likely that substantial waste in US health care spending remains. Objectives: To estimate current levels of waste in the US…
How Much Does Medication Nonadherence Cost the Medicare Fee-for-Service Program
BACKGROUND: Medication adherence is associated with lower health care utilization and savings in specific patient populations; however, few empirical estimates exist at the population level. OBJECTIVE: The main objective of this study was to apply a data-driven approach to obtain population-level estimates of the impact of medication nonadherence among Medicare beneficiaries with chronic conditions. RESEARCH DESIGN: Medicare fee-for-service (FFS)…
Costly New Alzheimer Disease Medications on the Horizon—Financing Alternatives for Medicare
Sungchul Park, PhD; Lindsay White, PhD; Paul Fishman, PhD; Eric B. Larson, MD, MPH; Norma B. Coe, PhD
A Private-Sector Partnership to Promote Equitable Vaccine Delivery
The COVID-19 pandemic has laid bare deep, extensive, and intractable racial/ethnic disparities in the health care system. Compared with White individuals in the US, Black and Hispanic individuals have been 30% and 69% more likely, respectively, to contract COVID-19, and 42% and 22% more likely to die from the disease. Black and Hispanic individuals in the US have been 2 to 3 times more likely to experience economic hardship during the pandemic. 2…
Comparison of Health Care Utilization by Medicare Advantage and Traditional Medicare Beneficiaries With Complex Care Needs
In this cross-sectional study of Medicare beneficiaries with complex care needs, those enrolled in MA had lower rates of hospital stays, ED visits, and 30-day readmissions than similar beneficiaries enrolled in TM, suggesting that managed care activities in MA may influence the nature and quality of care provided to these beneficiaries
Comparison of Low-Value Services Among Medicare Advantage and Traditional Medicare Beneficiaries
In this cross-sectional study of Medicare beneficiaries, those enrolled in MA had lower rates of low-value care than those enrolled in TM; elements of insurance design present in the MA program and absent in TM were associated with reduction in low-value care
Association Between Self-reported Health-Related Social Needs and Acute Care Utilization Among Older Adults Enrolled in Medicare Advantage
In this cross-sectional study of older adults enrolled in Medicare Advantage, self-reported HRSNs were common and associated with statistically significantly increased rates of acute care utilization, with variation in which HRSNs were associated with different utilization measures. These findings provide evidence of the unique association between certain HRSNs and different types of acute care utilization, which could help refine the development…
Association Between Community-Level Social Risk and Spending Among Medicare Beneficiaries
In this cross-sectional study of Medicare beneficiaries, the ADI explained little variation in health care spending, was negatively correlated with spending conditional on demographic and clinical characteristics, and was poorly correlated with self-reported social risk factors. This prompts caution and nuance when using community-level measures of social risk such as the ADI for social risk adjustment within Medicare value-based payment programs
Association Between a Bundled Payment Program for Lower Extremity Joint Replacement and Patient Outcomes Among Medicare Advantage Beneficiaries
In this study of an LEJR bundled payment program offered by a national Medicare Advantage insurer, findings suggest that physician practice participation in the program was associated with a decrease in episode spending without changes in quality. Bundled payments offered by private insurers, including Medicare Advantage plans, are an alternate payment option to fee for service that may reduce spending for LEJR episodes while maintaining quality …
Artificial Intelligence and Health Care Waste—Promise or Peril
This Viewpoint explores the opportunities and risks posed by AI in the health care system through the lens of the National Academy of Medicine’s framework of health care waste
Medicine (21 obras) · Medical prescription (11 obras) · Nursing (11 obras) · Family medicine (10 obras) · Health care (10 obras) · Medication Adherence and Compliance (10 obras) · Emergency Medicine (9 obras) · Internal Medicine (8 obras) · Pharmaceutical Practices and Patient Outcomes (8 obras) · Business (7 obras)