(Your article) exemplifies the high standard of excellence in research that merits this memorial to Dr. Eisenberg and his vision of translational research to move our field forward into evidence-based policy and practice.
Chiang-Hua Chang, PhD, MS
Paper Written by Dartmouth Institute Researchers Honored as 2018 John M. Eisenberg Article-of-the-Year in Health Services Research
An article authored by Dartmouth Institute Research Scientist Chiang-Hua Chang examining the effects of the primary care workforce on health outcomes over time has been selected as the 2018 John M. Eisenberg Article-of-the-Year in Health Services Research. Established in 2003, the annual award recognizes “excellent and original” research among all articles published in the Journal in the year prior to the award.
Chang and her co-authors, Dartmouth Institute Professors, James O’Malley and David Goodman, used American Medical Association (AMA) Masterfiles and fee-for-service Medicare claims for 2001 and 2011 to calculate two primary care workforce measures: the number of primary care physicians per 10,000 population (per capita) and the number of Medicare primary care full-time equivalents (FTEs) per 10,000 Medicare beneficiaries. (In contrast to this study, most of the previous studies on the effects of the primary care workforce did not examine the effects of workforce change over time.)
While the researchers found that overall Medicare beneficiaries’ health outcomes improved as the number of primary care physicians and their clinical effort increased, one unexpected finding was the relatively stronger growth in the clinical primary care FTEs per beneficiary than in primary care physicians per capita. Chang and her co-authors conclude that their findings not only support reform proposals advocated since the 1970s that herald primary care as the key to improving the healthcare delivery system, but also support the idea that “clinical effort provided by primary care physicians is more important than the headcount of local primary care physicians for better patient outcomes.”
“This study is a wonderful example of the work and the mindset The Dartmouth Institute is known for,” Director Elliott Fisher said. “We question conventionally accepted norms, not to prove them wrong, but to get the data we need to understand the big picture, to better allocate time and resources, and, ultimately, to achieve a higher-performing and more equitable system.”
Chang will receive the Eisenberg award at the annual Health Services Research Editorial Board meeting and dinner at the AcademyHealth Annual Research Meeting June 24 in Seattle, Washington.
Gap in substance abuse data could have long-term implications
A policy of redacting Medicare claims that included diagnosis or procedure codes related to substance abuse was in effect from 2013-2017, just as the Affordable Care Act and the opioid epidemic were drastically changing the healthcare landscape. To better understand the impact of the missing substance abuse data claims, a team of researchers from The Dartmouth Institute and the University of Michigan calculated the effect of redaction on prevalence estimates of common chronic conditions, such as hepatitis C and depression, as well as on inpatient use and spending.
Their findings, recently reported in Health Affairs, suggest four important implications of the redaction of substance abuse claims: Estimated co-morbidity in the population age 65 and older will be minimally affected; comorbidity for in the population younger than 65 will be understated, particularly for hepatitis C and mental illness; redaction could distort evidence on the treatment and outcomes of two important patient groups: those with hepatitis C who are taking new drugs such as Sofosbuvir and those at risk of overdose related to opioid use; research on inpatient use among Medicare beneficiaries younger than 65 will be limited.
“The redaction left a legacy that we very much need to be conscious of and continue to examine,” says lead author and Dartmouth Institute research scientist Andrea Austin, “particularly because it coincided with two monumental events in U.S. health care —implementation of the ACA and declining life expectancy.”