Evidence map›Paper›PMID 36175761›Full record

ArticleJournal of general internal medicine2023

Comparison of Low-Value Care Among Commercial and Medicaid Enrollees.

Jacqueline E Ellison, Soryan Kumar, Jon A Steingrimsson, Deepak Adhikari, Christina J Charlesworth, K John McConnell, Amal N Trivedi, Thomas A Trikalinos, Shaun P Forbes, Orestis A Panagiotou

Abstract read
In one paragraph

Article in Journal of general internal medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Jacqueline E EllisonDepartment of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
Soryan KumarWarren Alpert Medical School of Brown University, Providence, RI, USA.
Jon A SteingrimssonCenter for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA.
Deepak AdhikariConcertAI, Memphis, TN, USA.
Christina J CharlesworthCenter for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA.
K John McConnellCenter for Health Systems Effectiveness, Oregon Health & Science University, Portland, OR, USA.
Amal N TrivediDepartment of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
Thomas A TrikalinosDepartment of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
Shaun P ForbesDepartment of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.
Orestis A PanagiotouDepartment of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA. orestis_panagiotou@brown.edu.ORCID 0000-0001-9604-8380

Funding

Tracking and Evaluation CoreU54GM115677 · NIGMS · BROWN UNIVERSITY · PI SCHMID, CHRISTOPHER H. · 2016 to 2025
$45.0M
National Research Service AwardT32HS000011 · AHRQ · BROWN UNIVERSITY · PI TRIVEDI, AMAL N. · 1986 to 2024
$6.1M
AHRQ HHS 5T32 HS000011AHRQ HHS T32 HS000011NIGMS NIH HHS U54 GM115677NIGMS NIH HHS U54GM115677
6 · The paper itself

Abstract

backgroundLow-value healthcare is costly and inefficient and may adversely affect patient outcomes. Despite increases in low-value service use, little is known about how the receipt of low-value care differs across payers.

objectiveTo evaluate differences in the use of low-value care between patients with commercial versus Medicaid coverage.

designRetrospective observational analysis of the 2017 Rhode Island All-payer Claims Database, estimating the probability of receiving each of 14 low-value services between commercial and Medicaid enrollees, adjusting for patient sociodemographic and clinical characteristics. Ensemble machine learning minimized the possibility of model misspecification.

participantsMedicaid and commercial enrollees aged 18-64 with continuous coverage and an encounter at which they were at risk of receiving a low-value service.

interventionEnrollment in Medicaid or Commercial insurance. MAIN MEASURES: Use of one of 14 validated measures of low-value care. KEY

resultsAmong 110,609 patients, Medicaid enrollees were younger, had more comorbidities, and were more likely to be female than commercial enrollees. Medicaid enrollees had higher rates of use for 7 low-value care measures, and those with commercial coverage had higher rates for 5 measures. Across all measures of low-value care, commercial enrollees received more (risk difference [RD] 6.8 percentage points; CI: 6.6 to 7.0) low-value services than their counterparts with Medicaid. Commercial enrollees were also more likely to receive low-value services typically performed in the emergency room (RD 11.4 percentage points; CI: 10.7 to 12.2) and services that were less expensive (RD 15.3 percentage points; CI 14.6 to 16.0).

conclusionDifferences in the provision of low-value care varied across measures, though average use was slightly higher among commercial than Medicaid enrollees. This difference was more pronounced for less expensive services indicating that financial incentives may not be the sole driver of low-value care.

Indexed as

Low-Value CareMedicaidDelivery of Health CareFemaleHumansMaleRetrospective StudiesRhode IslandUnited Statescommercial insurancelow-value caremachine learningmedicaidphysician reimbursementtargeted maximum likelihood estimation (TMLE)

Identifiers

PMID36175761
PMCPMC10039208

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.