Propensity Score Matching Regression Research Articles

Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer

Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program. To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. This observational study from January 1, 2012, through December 31, 2015, used propensity score-matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015. The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter). Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions). In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214 patients in the matched nonnavigated comparison group. Compared with the matched comparison group, the mean total costs declined by $781.29 more per quarter per navigated patient (β = -781.29, SE = 45.77, P < .001), for an estimated $19 million decline per year across the network. Inpatient and outpatient costs had the largest between-group quarterly declines, at $294 and $275, respectively, per patient. Emergency department visits, hospitalizations, and intensive care unit admissions decreased by 6.0%, 7.9%, and 10.6%, respectively, per quarter in navigated patients compared with matched comparison patients (P < .001). Costs to Medicare and health care use from 2012 through 2015 declined significantly for navigated patients compared with matched comparison patients. Lay navigation programs should be expanded as health systems transition to value-based health care.

Perceived and Objectively-Measured Neighborhood Violence and Adolescent Psychological Distress.

Prior research examining links between neighborhood violence and mental health has not been able to establish whether it is perceived levels of neighborhood violence, or actual levels of violent crime, that matter most for adolescents' psychological well-being. In this study, we ascertained both perceived neighborhood safety and objectively-measured neighborhood-level violent crime (using a novel geospatial index of police-reported crime incidents) for 4464 adolescent respondents from the California Health Interview Survey (CHIS 2011-2014). We used propensity score-matched regression models to examine associations between these measures and CHIS adolescents' symptoms of psychological distress. We found that adolescents who perceived their neighborhood to be unsafe were two times more likely than those who perceived their neighborhood to be safe to report serious psychological distress (OR = 2.4, 95% CI = 1.20, 4.96). Adolescents who lived in areas objectively characterized by high levels of violent crime, however, were no more likely than their peers in safer areas to be distressed (OR = 1.41; 95% CI = 0.60, 3.32). Our results suggest that, at the population level, adolescents' perceptions of neighborhood violence, rather than objective levels of neighborhood crime, are most salient for their mental health.

Household instability and self-regulation among poor children.

Past research suggests that poverty may negatively influence children's psychological and behavioral health by increasing their exposure to chaotic living conditions in the household. The present study provides a descriptive 'snapshot' of instability in low-income households, and examines the associations between exposure to major destabilizing events over the course of a year and three domains of poor urban children's self-regulation. Descriptive analyses suggest that although caregivers from unstable households report higher average levels of health problems and depression, they also have greater assets/savings, are more educated, and are less likely to be immigrants than caregivers from stable households. Results of propensity score-matched regression analyses reveal that high levels of household instability are significantly and negatively associated with preschoolers' effortful control and global attention/impulsivity control, but not with their executive function. Children from mildly unstable homes (i.e., those who had experienced a single destabilizing event in the past year) showed no significant differences in any domain of self-regulation relative to their peers from stable households, suggesting a dose-response relationship between the number of destabilizing events experienced by children and their outcomes. Implications for theories of poverty-related adversity, stress, and parenting are discussed in addition to future directions for research.

Personal Health Record Use and Association with Immunizations and Well-Child Care Visits Recommendations

To determine the association of parental use of integrated personal health records (PHRs) with children's adherence to immunization and well-child care (WCC) visit recommendations. For the immunization and WCC visit measures, we retrospectively analyzed, respectively, 766 and 639 matched pairs at Kaiser Permanente (KP) Hawaii and 2795 and 2448 pairs at KP Northwest who were ≤ 31 days old at enrollment and continuously enrolled for 2 years between January 2007 and July 2011. The independent variable (≥ 1 PHR feature used vs none) was matched using propensity scores on parental and children characteristics. The dependent variables were 2 measures from the 2010 Healthcare Effectiveness Data and Information Set: combination 2 immunization (all immunizations vs <all) and number of WCC visits through 15 months old (≥ 6 vs <6). We conducted multivariate logistic, propensity score-matched regression adjusting for parents' education and child's continuity of care. Children whose parents used ≥ 1 PHR feature (vs none) had higher odds of adhering to the recommended immunizations only at KP Northwest (KP Hawaii: OR 1.1, 95% CI 0.8-1.4, P > .05; KP Northwest OR 1.2, 95% CI 1.0-1.3, P < .05). PHR use was associated with better adherence to WCC visit recommendations for both KP Hawaii (OR 1.9, 95% CI 1.3-2.9, P < .001) and KP Northwest (OR 2.5, 95% CI 2.1-2.9, P < .001). Young children whose parents used a PHR were more likely to adhere to the recommended WCC visits in both regions but immunizations in only 1 region.