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Access to health care services

Chapter by: Billings, John; Cantor, J
in: Jonas and Kovner's health care delivery in the United States by Kovner, Anthony R; Knickman, James; Jonas, Steven [Eds]
New York, NY : Springer Pub. Co., c2008
pp. ?-?
ISBN: 0826120989
CID: 1919832

Narrow model: The authors respond [Letter]

Billings, John; Mijanovich, Tod
ISI:000255579900054
ISSN: 0278-2715
CID: 1929252

Some reflections on a few of the pitfalls in the world of foundation grant making

Billings, John
This paper offers some reflections on the grant-making process from a former foundation executive. Some of the opportunities, challenges, and pitfalls inherent in the foundation world are described, and one approach to grant making, the "call for proposals," is examined as an example of the need for greater attention to and investment in the science of grant making itself, to maximize the potential return from philanthropy.
PMID: 17978397
ISSN: 0278-2715
CID: 278022

Improving the management of care for high-cost Medicaid patients

Billings, John; Mijanovich, Tod
Increased policy attention is being focused on the management of high-cost cases in Medicaid. In this paper we present an algorithm that identifies patients at high risk of future hospitalizations and offer a business-case analysis with a range of assumptions about the rate of reduction in future hospitalization and the cost of the intervention. The characteristics of the patients identified by the algorithm are described, and the implications of these findings for policymakers, payers, and providers interested in responding more effectively to the needs of these patients are discussed, including the challenges likely to be encountered in implementing an intervention initiative.
PMID: 17978384
ISSN: 0278-2715
CID: 278032

Competition on outcomes and physician leadership are not enough to reform health care

Dixon, Jennifer; Chantler, Cyril; Billings, John
PMID: 17895462
ISSN: 0098-7484
CID: 278042

Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients

Billings, John; Dixon, Jennifer; Mijanovich, Tod; Wennberg, David
OBJECTIVE: To develop a method of identifying patients at high risk of readmission to hospital in the next 12 months for practical use by primary care trusts and general practices in the NHS in England. DATA SOURCES: Data from hospital episode statistics showing all admissions in NHS trusts in England over five years, 1999-2000 to 2003-4; data from the 2001 census for England. Population All residents in England admitted to hospital in the previous four years with a subset of "reference" conditions for which improved management may help to prevent future admissions. DESIGN: Multivariate statistical analysis of routinely collected data to develop an algorithm to predict patients at highest risk of readmission in the next 12 months. The algorithm was developed by using a 10% sample of hospital episode statistics data for all of England for the period indicated. The coefficients for 21 most powerful (and statistically significant) variables were then applied against a second 10% test sample to validate the findings of the algorithm from the first sample. RESULTS: The key factors predicting subsequent admission included age, sex, ethnicity, number of previous admissions, and clinical condition. The algorithm produces a risk score (from 0 to 100) for each patient admitted with a reference condition. At a risk score threshold of 50, the algorithm identified 54.3% of patients admitted with a reference condition who would have an admission in the next 12 months; 34.7% of patients were "flagged" incorrectly (they would not have a subsequent admission). At risk score threshold levels of 70 and 80, the rate of incorrectly "flagged" patients dropped to 22.6% and 15.7%, but the algorithm found a lower percentage of patients who would be readmitted. The algorithm is made freely available to primary care trusts via a website. CONCLUSIONS: A method of predicting individual patients at highest risk of readmission to hospital in the next 12 months has been developed, which has a reasonable level of sensitivity and specificity. Using various assumptions a "business case" has been modelled to demonstrate to primary care trusts and practices the potential costs and impact of an intervention using the algorithm to reduce hospital admissions.
PMCID:1539047
PMID: 16815882
ISSN: 0959-8138
CID: 278052

New York's SSI medicaid beneficiaries : the move to managed care

Birnbaum, Michael; Billings, John
New York, N.Y. : Medicaid Institute at United Hospital Fund, [2006]
Extent: 11 p. ; 28 cm
ISBN: n/a
CID: 1930692

Access to care

Chapter by: Billings, John; Cantor, Joel C
in: Jonas & Kovner's health care delivery in the United States by Jonas, Steven; Kovner, Anthony R; Knickman, James [Eds]
New York : Springer Pub. Co., 2005
pp. ?-?
ISBN: 9780826120885
CID: 1919872

What matters to low-income patients in ambulatory care facilities?

DeLia, Derek; Hall, Allyson; Prinz, Timothy; Billings, John
Poor, uninsured, and minority patients depend disproportionately on hospital outpatient departments (OPDs) and freestanding health centers for ambulatory care. These providers confront significant challenges, including limited resources, greater demand for services, and the need to improve quality and patient satisfaction. The authors use a survey of patients in OPDs and health centers in New York City to determine which aspects of the ambulatory care visit have the greatest influence on patients' overall site evaluation. The personal interaction between patients and physicians, provider continuity, and the general cleanliness/appearance of the facility stand out as high priorities. Access to services and interactions with other facility staff are of significant, although lesser, importance. These findings suggest ways to restructure the delivery of care so that it is more responsive to the concerns of low-income patients.
PMID: 15358971
ISSN: 1077-5587
CID: 278072

Promoting the dissemination of decision aids: an odyssey in a dysfunctional health care financing system

Billings, John
The usefulness of patient decision aids (PtDAs) is well documented, yet they are not in widespread use. Barriers include assuring balance and fairness (auspices matter), the cost of producing and maintaining them, and getting them into the hands of patients at the right time. The Foundation for Informed Medical Decision Making and its for-profit partner, Health Dialog, have developed a creative business model that helps overcome these barriers and has greatly expanded the reach of decision aids.
PMID: 15471781
ISSN: 0278-2715
CID: 278062