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Article ; Online: Editorial: Healthcare organization and delivery strategies, models, and cost savings.

Xin, Haichang

2023 Volume 11, Page(s) 1255493

MeSH term(s)	Cost Savings ; Delivery of Health Care
Language	English
Publishing date	2023-08-21
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1255493
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Article ; Online: Patient Dissatisfaction With Primary Care and Nonurgent Emergency Department Use.

Xin, Haichang

The Journal of ambulatory care management

2019 Volume 42, Issue 4, Page(s) 284–294

Abstract: A well-functioning primary care system will have the capacity to provide timely, adequate, and effective care for patients to avoid nonurgent emergency department (ED) use. This study advances academic discussion by examining whether patient negative ... ...

Abstract	A well-functioning primary care system will have the capacity to provide timely, adequate, and effective care for patients to avoid nonurgent emergency department (ED) use. This study advances academic discussion by examining whether patient negative experiences during their encounter with a primary care physician (PCP) are associated with nonurgent ED use nationwide in the United States. This retrospective cohort study used data from the 2010-2011 Medical Expenditure Panel Survey. The independent measures were patient perceptions of PCPs' communication and care quality in 2010. The multivariate logit model was employed to analyze the nonurgent ED use as opposed to no ED use in 2011, after controlling for age, gender, race and ethnicity, rural/urban location, marital status, and education levels in 2010. All predictors were treated as dummy variables. We employed the lagged time effect and controlled health status to account for the endogeneity between outcomes and the main independent variables. The weights and variance were adjusted using the survey procedures to yield nationally representative results. The study sample consisted of 5242 adults, which represented 131 317 908 weighted people in the total population. While the measure of patient satisfaction with providers' communication was not associated with nonurgent ED use (P = .750), patient perceived poor and intermediary levels of primary care quality had higher odds of a nonurgent ED visit (OR = 1.75, P = .049, and OR = 1.48, P = .050, respectively) compared with high levels of care quality. For PCPs, endeavors may be considered in improving health care quality to reduce nonurgent ED use. Whenever possible, PCPs' efforts may want to be devoted to both communication and care quality to improve patients' health outcomes and satisfaction and to reduce nonurgent ED use.
MeSH term(s)	Adolescent ; Adult ; Aged ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Patient Satisfaction ; Primary Health Care/statistics & numerical data ; Quality of Health Care ; Retrospective Studies ; United States
Language	English
Publishing date	2019-08-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	198845-1
ISSN	1550-3267 ; 0148-9917
ISSN (online)	1550-3267
ISSN	0148-9917
DOI	10.1097/JAC.0000000000000301
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Article: High-cost sharing policies and non-urgent emergency department visits.

Xin, Haichang

International journal of health care quality assurance

2018 Volume 31, Issue 7, Page(s) 735–745

Abstract: Purpose: The purpose of this paper is to examine whether high-cost-sharing ambulatory care policies affect non-urgent emergency department (ED) care utilization differently among individuals with and without chronic conditions.: Design/methodology/ ... ...

Abstract	Purpose: The purpose of this paper is to examine whether high-cost-sharing ambulatory care policies affect non-urgent emergency department (ED) care utilization differently among individuals with and without chronic conditions. Design/methodology/approach: This retrospective cohort study used 2010-2011 US Medical Expenditure Panel Survey data. Difference-in-difference methods, multivariate logit model and survey procedures were employed. Time lag effect was used to address endogeneity concerns. Findings: The sample included 4,347 individuals. Difference in non-urgent ED visits log odds between high- and low-cost-sharing policies was not significantly different between chronically ill and non-chronically ill individuals ( β=-0.48, p=0.42). Sensitivity analysis with 15 and 25 percent cost-sharing levels also generated consistent insignificant results ( p=0.33 and p=0.31, respectively). Ambulatory care incidence rates were not significantly different between high- and low-cost-sharing groups among chronically ill people (incidence rate ratio=0.849, p=0.069). Practical implications: High-cost-sharing ambulatory care policies were not associated with increased non-urgent ED care utilization among chronically ill and healthy people. The chronically ill patients may have retained sizable ambulatory care that was necessary to maintain their health. Health plans or employers may consider low-level cost-sharing policies for ambulatory care among chronically ill enrollees or employees. Originality/value: Findings contribute to insurance benefit design; i.e., whether high-cost-sharing ambulatory care policies should be implemented among chronically ill enrollees to maintain their health and save costs for health plans.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Cost Sharing ; Emergency Service, Hospital/economics ; Female ; Financing, Personal/economics ; Humans ; Insurance, Health/economics ; Male ; Middle Aged ; Patient Acceptance of Health Care ; Retrospective Studies ; Surveys and Questionnaires ; United States ; Young Adult
Language	English
Publishing date	2018-10-24
Publishing country	England
Document type	Journal Article
ZDB-ID	645125-1
ISSN	0952-6862 ; 1366-0756
ISSN	0952-6862 ; 1366-0756
DOI	10.1108/IJHCQA-05-2017-0089
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Article: Editorial: Health Disparities-An Important Public Health Policy Concern.

Xin, Haichang

Frontiers in public health

2017 Volume 5, Page(s) 99

Language	English
Publishing date	2017-05-03
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2711781-9
ISSN	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2017.00099
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Article: Racial Disparity in Localized Prostate Cancer Mortality.

Xin, Haichang

Journal of the National Medical Association

2017 Volume 109, Issue 2, Page(s) 86–92

Abstract: This study aims to examine racial differences in all-cause mortality between African American (AA) and non-African American localized prostate cancer patients. This study advances academic discussion by being among the first to use a sample more ... ...

Abstract	This study aims to examine racial differences in all-cause mortality between African American (AA) and non-African American localized prostate cancer patients. This study advances academic discussion by being among the first to use a sample more representative of the general population that is different from certain subpopulations examined in literature. This study adopted a retrospective cohort study design using the Florida Cancer Data System. The hierarchical logistic regression was employed to analyze mortality in 2004 among living patients with localized prostate cancer from baseline 2000. Among 9617 patients, the odds of mortality in AAs were 57.6% higher than the non-AAs (Adjusted OR = 1.576, 95% CI: 1.243-1.999). Among prostate cancer patients, AA, older age, unmarried status, conservative treatment, Medicaid, and tumor grade III diagnosis predicted higher mortality relative to the reference group. Screening programs at a younger age can be considered, family and community support and aggressive treatments are suggested to prevent AA against adverse health outcomes.
MeSH term(s)	African Americans ; Aged ; Aged, 80 and over ; Florida/epidemiology ; Health Status Disparities ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prostatic Neoplasms/ethnology ; Prostatic Neoplasms/mortality ; Prostatic Neoplasms/therapy ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2017-02-14
Publishing country	United States
Document type	Journal Article
ZDB-ID	419737-9
ISSN	0027-9684
ISSN	0027-9684
DOI	10.1016/j.jnma.2017.01.007
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Article ; Online: Experiences and Lessons from Urban Health Insurance Reform in China.

Xin, Haichang

Population health management

2016 Volume 19, Issue 4, Page(s) 291–297

Abstract: Health care systems often face competing goals and priorities, which make reforms challenging. This study analyzed factors influencing the success of a health care system based on urban health insurance reform evolution in China, and offers ... ...

Abstract	Health care systems often face competing goals and priorities, which make reforms challenging. This study analyzed factors influencing the success of a health care system based on urban health insurance reform evolution in China, and offers recommendations for improvement. Findings based on health insurance reform strategies and mechanisms that did or did not work can effectively inform improvement of health insurance system design and practice, and overall health care system performance, including equity, efficiency, effectiveness, cost, finance, access, and coverage, both in China and other countries. This study is the first to use historical comparison to examine the success and failure of China's health care system over time before and after the economic reform in the 1980s. This study is also among the first to analyze the determinants of Chinese health system effectiveness by relating its performance to both technical reasons within the health system and underlying nontechnical characteristics outside the health system, including socioeconomics, politics, culture, values, and beliefs. In conclusion, a health insurance system is successful when it fits its social environment, economic framework, and cultural context, which translates to congruent health care policies, strategies, organization, and delivery. No health system can survive without its deeply rooted socioeconomic environment and cultural context. That is why one society should be cautious not to radically switch from a successful model to an entirely different one over time. There is no perfect health system model suitable for every population-only appropriate ones for specific nations and specific populations at the right place and right time. (Population Health Management 2016;19:291-297).
MeSH term(s)	China ; Culture ; Health Care Reform ; Insurance, Health ; Social Class ; Urban Population
Language	English
Publishing date	2016
Publishing country	United States
Document type	Journal Article
ZDB-ID	2454546-6
ISSN	1942-7905 ; 1942-7891
ISSN (online)	1942-7905
ISSN	1942-7891
DOI	10.1089/pop.2015.0086
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Article ; Online: How do high cost-sharing policies for physician care affect inpatient care use and costs among people with chronic disease?

Xin, Haichang

The Journal of ambulatory care management

2015 Volume 38, Issue 2, Page(s) 100–108

Abstract: Rapidly rising health care costs continue to be a significant concern in the United States. High cost-sharing strategies thus have been widely used to address rising health care costs. Since high cost-sharing policies can reduce needed care as well as ... ...

Abstract	Rapidly rising health care costs continue to be a significant concern in the United States. High cost-sharing strategies thus have been widely used to address rising health care costs. Since high cost-sharing policies can reduce needed care as well as unneeded care use, it raises the concern whether these policies for physician care are a good strategy for controlling costs among chronically ill patients, especially whether utilization and costs in inpatient care will increase in response. This study examined whether high cost sharing in physician care affects inpatient care utilization and costs differently between individuals with and without chronic conditions. Findings from this study will contribute to the insurance benefit design that can control care utilization and save costs of chronically ill individuals. Prior studies suffered from gaps that limit both internal validity and external validity of their findings. This study has its unique contributions by filling these gaps jointly. The study used data from the 2007 Medical Expenditure Panel Survey, a nationally representative sample, with a cross-sectional study design. Instrumental variable technique was used to address the endogeneity between health care utilization and cost-sharing levels. We used negative binomial regression to analyze the count data and generalized linear models for costs data. To account for national survey sampling design, weight and variance were adjusted. The study compared the effects of high cost-sharing policies on inpatient care utilization and costs between individuals with and without chronic conditions to answer the research question. The final study sample consisted of 4523 individuals; among them, 752 had hospitalizations. The multivariate analysis demonstrated consistent patterns. Compared with low cost-sharing policies, high cost-sharing policies for physician care were not associated with a greater increase in inpatient care utilization (P = .86 for chronically ill people and P = .67 for healthy people, respectively) and costs (P = .38 for chronically ill people and P = .68 for healthy people, respectively). The sensitivity analysis with a 10% cost-sharing level also generated consistent insignificant results for both chronically ill and healthy groups. Relative to nonchronically ill individuals, chronically ill individuals may increase their utilization and expenditures of inpatient care to a similar extent in response to increased physician care cost sharing. This may be due to cost pressure from inpatient care and short observation window. Although this study did not find evidence that high cost-sharing policies for physician care increase inpatient care differently for individuals with and without chronic conditions, interpretation of this finding should be cautious. It is possible that in the long run, these sick people would demonstrate substantial demands for medical care and there could be a total cost increase for health plans ultimately. Health plans need to be cautious of policies for chronically ill enrollees.
MeSH term(s)	Adolescent ; Adult ; Aged ; Chronic Disease/economics ; Cost Sharing ; Cross-Sectional Studies ; Female ; Health Services/utilization ; Hospitalization/economics ; Humans ; Insurance, Health ; Male ; Middle Aged ; Surveys and Questionnaires ; Young Adult
Language	English
Publishing date	2015-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	198845-1
ISSN	1550-3267 ; 0148-9917
ISSN (online)	1550-3267
ISSN	0148-9917
DOI	10.1097/JAC.0000000000000050
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Article ; Online: Evaluation of electronic measurement of capillary refill for Sepsis screening at ED triage.

Hansen, Matthew / Gillespie, Jordan / Riddick, Tyne / Samatham, Ravi / Baker, Steven / Filer, Scott / Xin, Haichang / Sheridan, David

The American journal of emergency medicine

2023 Volume 70, Page(s) 61–65

Abstract: Objective: To evaluate the association between capillary refill time (CRT) measured by a medical device and sepsis among patients presenting to the Emergency Department (ED).: Methods: This prospective observational study enrolled adult and pediatric ...

Abstract	Objective: To evaluate the association between capillary refill time (CRT) measured by a medical device and sepsis among patients presenting to the Emergency Department (ED). Methods: This prospective observational study enrolled adult and pediatric patients during ED triage when sepsis was considered a potential diagnosis by the triage nurse. Patients were enrolled at an academic medical center between December 2020 and June 2022. CRT was measured by a research assistant using an investigational medical device. The outcomes included sepsis and septic shock defined using sep-3 criteria, septic shock defined as IV antibiotics and a vasopressor requirement, ICU admission, and hospital mortality. Other measures included patient demographics and vital signs at ED triage. We evaluated univariate associations between CRT and sepsis outcomes. Results: We enrolled 563 patients in the study, 48 met Sep-3 criteria, 5 met Sep-3 shock criteria, and 11 met prior septic shock criteria (IV antibiotics and vasopressors to maintain mean arterial pressure of 65). Sixteen patients were admitted to the ICU. The mean age was 49.1 years, and 51% of the cohort was female. The device measured CRT was significantly associated with the diagnosis of sepsis by sep-3 criteria (OR 1.23, 95% CI 1.06-1-43), septic shock by sep-3 criteria (OR 1.57, 95% CI 1.02-2.40), and septic shock defined as receipt of IV antibiotics and a vasopressor requirement (OR 1.37, 95% CI 1.03-1.82). Patients with CRT >3.5 s measured by the DCR device had an odds ratio of 4.67 (95%CI 1.31-16.1) of septic shock (prior definition), and an odds ratio of 3.97 (95% CI 1.99-7.92) of ICU admission, supporting the potential for the 3.5-s cutoff of the DCR measurement. Conclusions: CRT measured by a medical device at ED triage was associated with the diagnosis of sepsis. Objective CRT measurement using a medical device may be a relatively simple way to improve sepsis diagnosis during ED triage.
MeSH term(s)	Adult ; Humans ; Female ; Child ; Middle Aged ; Shock, Septic ; Triage ; Retrospective Studies ; Sepsis ; Emergency Service, Hospital ; Vasoconstrictor Agents/therapeutic use ; Hospital Mortality ; Anti-Bacterial Agents
Chemical Substances	Vasoconstrictor Agents ; Anti-Bacterial Agents
Language	English
Publishing date	2023-05-11
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	605890-5
ISSN	1532-8171 ; 0735-6757
ISSN (online)	1532-8171
ISSN	0735-6757
DOI	10.1016/j.ajem.2023.05.009
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Article: Examining the Impact of Refractory Myasthenia Gravis on Healthcare Resource Utilization in the United States: Analysis of a Myasthenia Gravis Foundation of America Patient Registry Sample.

Xin, Haichang / Harris, Linda A / Aban, Inmaculada B / Cutter, Gary

Journal of clinical neurology (Seoul, Korea)

2019 Volume 15, Issue 3, Page(s) 376–385

Abstract: Background and purpose: Patients with refractory myasthenia gravis (MG) experience ongoing disease burden that might be reflected in their healthcare utilization. Here we examine the impact of refractory MG on healthcare utilization.: Methods: The ... ...

Abstract	Background and purpose: Patients with refractory myasthenia gravis (MG) experience ongoing disease burden that might be reflected in their healthcare utilization. Here we examine the impact of refractory MG on healthcare utilization. Methods: The 825 included participants were aged 18-64 years, enrolled in the Myasthenia Gravis Foundation of America Patient Registry between July 2013 and February 2018, and had been diagnosed with MG ≥2 years previously. Results: Participants comprised 76 (9.2%) with refractory MG and 749 (90.8%) with nonrefractory MG. During the 6 months before enrollment, participants with refractory MG were significantly more likely than those with nonrefractory MG to have experienced at least one exacerbation [67.1% vs. 52.0%, respectively, Conclusions: Refractory MG is associated with higher disease burden and healthcare utilization than nonrefractory MG.
Language	English
Publishing date	2019-07-09
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2500489-X
ISSN	2005-5013 ; 1738-6586
ISSN (online)	2005-5013
ISSN	1738-6586
DOI	10.3988/jcn.2019.15.3.376
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Article ; Online: Employment in refractory myasthenia gravis: A Myasthenia Gravis Foundation of America Registry analysis.

Harris, Linda / Aban, Inmaculada B / Xin, Haichang / Cutter, Gary

Muscle & nerve

2019 Volume 60, Issue 6, Page(s) 700–706

Abstract: Introduction: Labor-market participation is potentially very difficult for patients with refractory myasthenia gravis (MG). In this study, employment status and work absences are compared between refractory and nonrefractory MG.: Methods: Adults ( ... ...

Abstract	Introduction: Labor-market participation is potentially very difficult for patients with refractory myasthenia gravis (MG). In this study, employment status and work absences are compared between refractory and nonrefractory MG. Methods: Adults (aged 18-64 years, all diagnosed ≥2 years previously) were included if enrolled in the Myasthenia Gravis Foundation of America Patient Registry during July 2013 to February 2018. Results: Seventy-six patients (9.2%) had refractory and 749 (90.8%) had nonrefractory disease; demographic data did not differ between groups. Relative to the nonrefractory group, the refractory group patients were more than twice as likely to work fewer hours per week (odds ratio [95% confidence interval]: currently employed, 2.777 [1.640-4.704]; employed over previous 6 months, 2.643 [1.595-4.380]), but those employed were not more likely to be absent from work. Discussion: Because absence from the labor market adversely affects quality of life and personal finances, these findings reaffirm the considerable disease burden associated with refractory MG.
MeSH term(s)	Adolescent ; Adult ; Employment/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Myasthenia Gravis/physiopathology ; Myasthenia Gravis/therapy ; Sick Leave/statistics & numerical data ; Treatment Failure ; Unemployment/statistics & numerical data ; Young Adult
Language	English
Publishing date	2019-10-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	438353-9
ISSN	1097-4598 ; 0148-639X
ISSN (online)	1097-4598
ISSN	0148-639X
DOI	10.1002/mus.26694
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