National Healthcare Quality and Disparities Report
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Topics
- Adverse Drug Events (ADE) (1)
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- Blood Clots (1)
- Burnout (2)
- Cancer (3)
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- Healthcare-Associated Infections (HAIs) (6)
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- (-) Provider Performance (106)
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- Simulation (1)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 106 Research Studies DisplayedSen AP, Chen LM, Wong Samson L
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
The purpose of this study was to examine performance by accountable care organizations (ACOs) in the top quintile of their proportion of beneficiaries who were dually enrolled in Medicare and Medicaid (high-dual), and the top quintile of disabled beneficiaries (high-disabled). Measures used were quality scores, savings per beneficiary, whether or not the ACO shared savings and the amount of shared savings. The researchers found that high-dual and high-disabled ACOs had similar or higher spending than other ACOs at baseline, but achieved greater savings and were equally or more likely to earn shared savings; alternative payment models can have positive financial outcomes for providers serving vulnerable populations.
AHRQ-funded; HS024698.
Citation: Sen AP, Chen LM, Wong Samson L .
Performance in the Medicare Shared Savings Program by accountable care organizations disproportionately serving dual and disabled populations.
Med Care 2018 Sep;56(9):805-11. doi: 10.1097/mlr.0000000000000968..
Keywords: Disabilities, Medicare, Healthcare Costs, Provider Performance, Payment, Low-Income, Vulnerable Populations
Hays RD, Mallett JS, Haas A
Associations of CAHPS composites with global ratings of the doctor vary by Medicare beneficiaries' health status.
This study examines whether the association of care coordination with global ratings of one's personal doctor varies by number of chronic conditions and self-rated health. Results were consistent with the hypothesis that patients in worse health weigh care coordination more heavily in global physician assessments than patients in better health. Emphasis on improving care coordination, especially for patients in poorer health, may improve patients' overall assessments of their providers.
AHRQ-funded; HS016980; HS025920.
Citation: Hays RD, Mallett JS, Haas A .
Associations of CAHPS composites with global ratings of the doctor vary by Medicare beneficiaries' health status.
Med Care 2018 Aug;56(8):736-39. doi: 10.1097/mlr.0000000000000942..
Keywords: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Quality of Care, Health Status, Medicare, Provider Performance
Markovitz AA, Ramsay PP, Shortell SM
Financial incentives and physician practice participation in Medicare's value-based reforms.
The purpose of this study was to evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. The authors concluded that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale.
AHRQ-funded; HS018546.
Citation: Markovitz AA, Ramsay PP, Shortell SM .
Financial incentives and physician practice participation in Medicare's value-based reforms.
Health Serv Res 2018 Aug;53 Suppl 1:3052-69. doi: 10.1111/1475-6773.12743..
Keywords: Payment, Medicare, Provider Performance
Dowding D, Merrill JA
The development of heuristics for evaluation of dashboard visualizations.
Heuristic evaluation is used in human-computer interaction studies to assess the usability of information systems. This article develops a heuristic evaluation checklist that can be used to evaluate systems that produce information visualizations. The authors suggest that a checklist of usability heuristics for evaluating information visualization systems can contribute to assuring high quality in electronic data systems developed for health care.
AHRQ-funded; HS023855.
Citation: Dowding D, Merrill JA .
The development of heuristics for evaluation of dashboard visualizations.
Appl Clin Inform 2018 Jul;9(3):511-18. doi: 10.1055/s-0038-1666842..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider Performance, Quality of Care, Quality Improvement
Alexander GL, Madsen R
A national report of nursing home quality and information technology: two-year trends.
The authors sought to answer these two research questions: What are the trends in information technology (IT) adoption in US nursing home facilities over 2 years? How are 2-year trends in IT adoption in US nursing homes related to nationally reported quality measures (QMs)? Using surveys of nursing home administrators and data from Nursing Home Compare, they concluded that multiple dimensions of IT sophistication influence QMs in every health care domain, providing an opportunity to design a reporting system that joins these important variables to be assessed on a national scale.
AHRQ-funded; HS022497.
Citation: Alexander GL, Madsen R .
A national report of nursing home quality and information technology: two-year trends.
J Nurs Care Qual 2018 Jul/Sep;33(3):200-07. doi: 10.1097/ncq.0000000000000328.
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Keywords: Health Information Technology (HIT), Nursing Homes, Long-Term Care, Quality of Care, Quality Measures, Provider Performance
Le Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
The objective of the study was to compare in-hospital emergency medicine (EM) trainees' performance on endotracheal intubation (ETI) delivered from both the seated and standing positions. The study concluded that the position of the in-hospital provider, whether seated or standing, had no effect on the provider's ETI performance. Since environmental circumstances sometimes necessitate alternative positioning for effective ETI administration, the findings suggest that there may be value in training residents to perform ETI from both positions.
AHRQ-funded; HS021456.
Citation: Le Parc JM, Bischof JJ, King AM JM, Bischof JJ, King AM .
A randomized comparison of in-hospital rescuer positions for endotracheal intubation in a difficult airway.
West J Emerg Med 2018 Jul;19(4):660-67. doi: 10.5811/westjem.2018.4.37227..
Keywords: Education: Continuing Medical Education, Emergency Medical Services (EMS), Patient Safety, Provider Performance
Wey A, Salkowski N, Kasiske BL
A five-tier system for improving the categorization of transplant program performance.
The purpose of this study was to better inform health care consumers by identifying the differences in transplant program performance. Researchers compared the differentiation of program performance and a simulated misclassification rate of the five-tier system with the previous three-tier system based on the 95 percent credible interval, using data on adult kidney transplants collected from the Scientific Registry of Transplant Recipients database. The study finds that the five-tier system improved differentiation and maintained a lower misclassification rate than programs differing by two tiers, and concludes that the five-tier system can improve the informing of health care consumers about transplant program performance.
AHRQ-funded; HS024527.
Citation: Wey A, Salkowski N, Kasiske BL .
A five-tier system for improving the categorization of transplant program performance.
Health Serv Res 2018 Jun;53(3):1979-91. doi: 10.1111/1475-6773.12726..
Keywords: Transplantation, Provider Performance, Quality of Care, Registries
de la Guardia FH, Hwang J, Adams JL
https://doi.org/10.1007/s10742-018-0179-2
Loss function-based evaluation of physician report cards.
The authors specified loss functions and evaluated the potential cost of misclassification for physician report card designs. They found that misclassification cost depends on how performance information will be used and by whom; selecting the lowest-cost design for a given stakeholder could maximize the usefulness of physician performance data. They conlcuded that misclassification cost could guide report card design, improving the usefulness of a report card for one stakeholder without disadvantaging others.
AHRQ-funded; HS021860.
Citation: de la Guardia FH, Hwang J, Adams JL .
Loss function-based evaluation of physician report cards.
Health Services and Outcomes Research Methodology 2018 Jun;18(2):96-108. doi: 10.1007/s10742-018-0179-2.
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Keywords: Quality of Care, Provider Performance, Quality Measures
Suckow BD, Goodney PP, Columbo JA
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
Open repair effectively prevents rupture for patients with abdominal aortic aneurysm (AAA) and is commonly studied as a metric reflecting hospital and surgeon expertise in cardiovascular care. However, given recent advances in endovascular aneurysm repair (EVAR), such as branched-fenestrated EVAR, it is unknown how commonly open surgical repair is still used in everyday practice. This study analyzed trends in open AAA repair, EVAR, and branched-fenestrated EVAR for AAA in Medicare beneficiaries from 2003 to 2013.
AHRQ-funded; HS021581.
Citation: Suckow BD, Goodney PP, Columbo JA .
National trends in open surgical, endovascular, and branched-fenestrated endovascular aortic aneurysm repair in Medicare patients.
J Vasc Surg 2018 Jun;67(6):1690-97.e1. doi: 10.1016/j.jvs.2017.09.046..
Keywords: Cardiovascular Conditions, Medicare, Provider Performance, Quality Measures, Surgery
Boyle WA, Murray DJ, Beyatte MB
Simulation-based assessment of critical care "front-line" providers.
The researchers developed a standardized simulation method to assess clinical skills of ICU providers. Their simulation assessments yielded reasonably reliable measures of Critical Care Medicine decision-making skills. Despite a wide range of performance, those with more ICU training and experience performed better, providing evidence to support the validity of the scores.
AHRQ-funded; HS018734; HS022265.
Citation: Boyle WA, Murray DJ, Beyatte MB .
Simulation-based assessment of critical care "front-line" providers.
Crit Care Med 2018 Jun;46(6):e516-e22. doi: 10.1097/ccm.0000000000003073.
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Keywords: Critical Care, Shared Decision Making, Intensive Care Unit (ICU), Provider Performance, Training
Niknam BA, Arriaga AF, Rosenbaum PR
Adjustment for atherosclerosis diagnosis distorts the effects of percutaneous coronary intervention and the ranking of hospital performance.
The researchers investigated how adjustment for atherosclerosis affects rankings of hospitals that perform percutaneous coronary intervention (PCI). They found that atherosclerosis is almost always noted in patients with acute myocardial infarction (AMI) who undergo interventional cardiology but less often in medically managed patients, so adjustment for its notation likely removes part of the effect of interventional treatment. Thus, hospitals performing more extensive imaging and more PCIs have higher atherosclerosis diagnosis rates, making their patients appear healthier and artificially reducing the expected mortality rate against which they are benchmarked. The authors concluded that atherosclerosis adjustment is detrimental to hospitals providing more thorough AMI care.
AHRQ-funded; HS023560.
Citation: Niknam BA, Arriaga AF, Rosenbaum PR .
Adjustment for atherosclerosis diagnosis distorts the effects of percutaneous coronary intervention and the ranking of hospital performance.
J Am Heart Assoc 2018 May 25;7(11). doi: 10.1161/jaha.117.008366.
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Keywords: Cardiovascular Conditions, Outcomes, Heart Disease and Health, Provider Performance, Quality Measures
Stevens H, Carlin AM, Ross R
Effect of surgeon age on bariatric surgery outcomes.
This study examined the effect of surgeon age on complication rates for bariatric surgery. A retrospective study was done with 71 surgeons in Michigan who participated in a statewide collaborative improvement program. Older surgeons performed more Roux-en Y Gastric Bypass (40%) and less sleeve gastrectomy (38.8%) than younger surgeons. There was not found to be any statistically significant differences in patient outcome between the two age groups.
AHRQ-funded; HS024403.
Citation: Stevens H, Carlin AM, Ross R .
Effect of surgeon age on bariatric surgery outcomes.
Ann Surg 2018 May;267(5):905-09. doi: 10.1097/sla.0000000000002297..
Keywords: Adverse Events, Obesity, Outcomes, Patient Safety, Provider, Provider: Physician, Provider Performance
Eze-Ajoku E, Lavoie M, DeCamp M
Exploring the evidence base behind quality measures.
This study examined the strength of evidence behind quality measures used in Medicare’s 2016 Shared Savings Program. These measures apply to more than 430 accountable care organizations (ACOs). Differences existed in the grading systems used and the evidentiary strength. Based on average ACO performance, performance appeared to be lower in the moderate evidence category (overall average, 61 percent) compared to the high evidence category (overall average, 77 percent).
AHRQ-funded; HS023684.
Citation: Eze-Ajoku E, Lavoie M, DeCamp M .
Exploring the evidence base behind quality measures.
Am J Med Qual 2018 May/Jun;33(3):321-22. doi: 10.1177/1062860617721645.
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Keywords: Evidence-Based Practice, Medicare, Payment, Provider Performance, Quality Measures
Bowen ME, Bhat D, Fish J
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
This before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement.
AHRQ-funded; HS022418.
Citation: Bowen ME, Bhat D, Fish J .
Improving performance on preventive health quality measures using clinical decision support to capture care done elsewhere and patient exceptions.
Am J Med Qual 2018 May/Jun;33(3):237-45. doi: 10.1177/1062860617732830..
Keywords: Clinical Decision Support (CDS), Prevention, Provider Performance, Quality Improvement, Quality Measures, Quality Measures
Nguyen OK, Makam AN, Clark C
Predicting 30-day hospital readmissions in acute myocardial infarction: the AMI "READMITS" (Renal Function, Elevated Brain Natriuretic Peptide, Age, Diabetes Mellitus, Nonmale Sex, Intervention with Timely Percutaneous Coronary Intervention, and Low Systo
This study sought to develop an actionable and accurate acute myocardial infarction (AMI) readmission risk prediction model to identify high-risk patients as early as possible during hospitalization. The investigators found that the parsimonious AMI READMITS score enables early prospective identification of high-risk AMI patients for targeted readmissions reduction interventions within the first 24 hours of hospitalization. A full-stay AMI readmission model only modestly outperformed the AMI READMITS score in terms of discrimination, but surprisingly did not meaningfully improve reclassification.
AHRQ-funded; HS022418.
Citation: Nguyen OK, Makam AN, Clark C .
Predicting 30-day hospital readmissions in acute myocardial infarction: the AMI "READMITS" (Renal Function, Elevated Brain Natriuretic Peptide, Age, Diabetes Mellitus, Nonmale Sex, Intervention with Timely Percutaneous Coronary Intervention, and Low Systo
J Am Heart Assoc 2018 Apr 17;7(8). doi: 10.1161/jaha.118.008882..
Keywords: Hospital Readmissions, Heart Disease and Health, Provider Performance, Risk
de Cordova PB
Excess mortality associated with weekend hospital admissions may be due to patient-level differences, rather than reduced staffing or services.
The author comments on a study by Walker that explained the weekend effect as arising from differences in patient characteristics among patients who present to the emergency department on the weekend. For staffing, Walker used a proxy measure because staffing information was not available. The author cautions that, although a clear rationale was provided, there should be acknowledgement that use of a proxy, whether for illness severity or staffing, may alter results.
AHRQ-funded; HS024339.
Citation: de Cordova PB .
Excess mortality associated with weekend hospital admissions may be due to patient-level differences, rather than reduced staffing or services.
Evid Based Nurs 2018 Apr;21(2):49. doi: 10.1136/eb-2017-102779.
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Keywords: Healthcare Delivery, Health Services Research (HSR), Hospitalization, Mortality, Provider Performance
Sheehan FH, Zierler RE
Simulation for competency assessment in vascular and cardiac ultrasound.
This paper discusses the use of simulation for competency-based medical education (CBME) in diagnostic ultrasound. The authors suggest that the use of simulation for CBME in diagnostic ultrasound is particularly appealing since it incorporates both the psychomotor and cognitive domains while eliminating dependency on the availability of live patients with a range of pathology. However, successful application of simulation in this setting requires realistic, full-featured simulators and appropriate standardized metrics for competency testing.
AHRQ-funded; HS024219.
Citation: Sheehan FH, Zierler RE .
Simulation for competency assessment in vascular and cardiac ultrasound.
Vasc Med 2018 Apr;23(2):172-80. doi: 10.1177/1358863x17751656..
Keywords: Education: Continuing Medical Education, Provider Performance
Sawyer JM, Anton NE, Korndorffer JR
Time crunch: increasing the efficiency of assessment of technical surgical skill via brief video clips.
Video review for assessment of surgical performance is gaining popularity but is time consuming for busy expert reviewers, making review delays inevitable. The study authors hypothesized that a shorter duration video clip would not affect the quality of expert ratings compared with full-length review. Their hypothesis was rejected as shorter video durations for surgical performance assessment led to inflated reviewer ratings both for expert and novice reviewers. They concluded that shortening duration of the video could not be recommended for accurate performance assessment.
AHRQ-funded; HS022080.
Citation: Sawyer JM, Anton NE, Korndorffer JR .
Time crunch: increasing the efficiency of assessment of technical surgical skill via brief video clips.
Surgery 2018 Apr;163(4):933-37. doi: 10.1016/j.surg.2017.11.011..
Keywords: Surgery, Quality of Care, Provider Performance, Quality Measures
Taylor LK, Thomas GW, Karam MD
Developing an objective assessment of surgical performance from operating room video and surgical imagery.
IISE Trans Healthc Syst Eng 2018;88(2):110-16. doi: 10.1080/24725579.2017.1418767.
An unbiased, repeatable process for assessing operating room performance is an important step toward quantifying the relationship between surgical training and performance. This study analyzed the following performance measures: duration of wire navigation, number of fluoroscopic images collected, degree of intervention by the surgeon's supervisor, and the tip-apex distance (TAD). The study results indicated that two metrics of hip fracture wire navigation performance, duration and TAD, significantly differentiated surgical experience.
An unbiased, repeatable process for assessing operating room performance is an important step toward quantifying the relationship between surgical training and performance. This study analyzed the following performance measures: duration of wire navigation, number of fluoroscopic images collected, degree of intervention by the surgeon's supervisor, and the tip-apex distance (TAD). The study results indicated that two metrics of hip fracture wire navigation performance, duration and TAD, significantly differentiated surgical experience.
AHRQ-funded; HS022077.
Citation: Taylor LK, Thomas GW, Karam MD .
Developing an objective assessment of surgical performance from operating room video and surgical imagery.
IISE Trans Healthc Syst Eng 2018;88(2):110-16. doi: 10.1080/24725579.2017.1418767..
Keywords: Provider Performance, Surgery, Training, Education: Continuing Medical Education
Ryskina KL, Konetzka RT, Werner RM
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
The goal of this study was to test whether the improvements in nursing homes’ 5-star ratings were correlated with reductions in rates of hospitalization; the researchers’ hypothesis was that increased attention to ratings motivated nursing homes to make changes to improve ratings but did not affect hospitalization rate, resulting in a weakened association between ratings and hospitalizations. 2007-2010 Medicare hospital claims and nursing home clinical assessment data were used to compare the correlation between nursing homes’ ratings and hospitalization rates. Correlation weakened slightly after the ratings became publicly available. The researchers conclude that improvements in nursing home ratings after the release of Medicare's 5-star rating system were not accompanied by improvements in a broader measure of outcomes for post-acute care patients and, although this dissociation may be due to additional factors, the 5-star ratings became less meaningful as an indicator of nursing home quality for these patients.
AHRQ-funded; HS021861.
Citation: Ryskina KL, Konetzka RT, Werner RM .
Association between 5-Star nursing home report card ratings and potentially preventable hospitalizations.
Inquiry 2018 Jan-Dec;55:46958018787323. doi: 10.1177/0046958018787323..
Keywords: Elderly, Nursing Homes, Medicare, Quality Indicators (QIs), Provider Performance, Quality Measures, Hospitalization, Quality of Care
Govindan S, Wallace B, Iwashyna TJ
Do experts understand performance measures? A mixed-methods study of infection preventionists.
This study assessed expert interpretation of CLABSI quality data using a cross-sectional survey of members of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). The investigators found that significant variability in the interpretation of CLABSI data exists among experts. They assert that this finding is likely related to data complexity, particularly with respect to risk-adjusted data. They suggest that improvements appear necessary in data sharing and public policy efforts to account for this complexity.
AHRQ-funded; HS022835.
Citation: Govindan S, Wallace B, Iwashyna TJ .
Do experts understand performance measures? A mixed-methods study of infection preventionists.
Infect Control Hosp Epidemiol 2018 Jan;39(1):71-76. doi: 10.1017/ice.2017.243..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Provider, Provider Performance, Quality of Care, Quality Measures
Catchpole K, Neyens DM, Abernathy J
Framework for direct observation of performance and safety in healthcare.
This viewpoint paper discusses non-participant direct observation of healthcare processes as a rich method for understanding safety and performance improvement. The authors suggest that as a prospective method for error prediction and modelling, observation can capture a broad range of performance issues that can be related to higher aspects of the system.
AHRQ-funded; HS024380.
Citation: Catchpole K, Neyens DM, Abernathy J .
Framework for direct observation of performance and safety in healthcare.
BMJ Qual Saf 2017 Dec;26(12):1015-21. doi: 10.1136/bmjqs-2016-006407..
Keywords: Healthcare Delivery, Patient Safety, Provider Performance, Quality Improvement
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
AHRQ-funded; HS021860.
Citation: Paddock SM, Damberg CL, Yanagihara D .
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
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Keywords: Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Masnick M, Morgan DJ, Sorkin JD
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
This study was designed to determine whether patients using the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website can use nationally reported healthcare-associated infection (HAI) data to differentiate hospitals. The authors concluded that HAI data generally are reported by enough hospitals to meet minimal criteria for useful comparisons in many geographic locations, though this varies by type of HAI.
AHRQ-funded; HS018111.
Citation: Masnick M, Morgan DJ, Sorkin JD .
Can national healthcare-associated infections (HAIs) data differentiate hospitals in the United States?
Infect Control Hosp Epidemiol 2017 Oct;38(10):1167-71. doi: 10.1017/ice.2017.179..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Hospitals, Provider Performance, Quality Measures
Adams JL, Paddock SM
Misclassification risk of tier-based physician quality performance systems.
The authors estimated misclassification rates for two-category high-quality physician identification systems. They found that current methods for profiling physicians on quality may produce misleading results, and that misclassification is a policy-relevant measure of the potential impact of tiering on providers, payers, and patients. They concluded that quantifying misclassification rates should inform the construction of high-performance networks and quality improvement initiatives.
AHRQ-funded; HS021860.
Citation: Adams JL, Paddock SM .
Misclassification risk of tier-based physician quality performance systems.
Health Serv Res 2017 Aug;52(4):1277-96. doi: 10.1111/1475-6773.12561.
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Keywords: Provider Performance, Quality of Care, Payment