Patrick Romano - Academia.edu (original) (raw)

Papers by Patrick Romano

Health Services Research, Jan 25, 2018

HSR Begins a New Era With the start of our 53rd volume in February 2018, Health Services Research... more HSR Begins a New Era With the start of our 53rd volume in February 2018, Health Services Research (HSR), an official journal of AcademyHealth published by the Health Research & Educational Trust (HRET), is beginning a new era. As the United States and other countries have embraced the triple aim of improving the quality and experience of health care, improving population health, and reducing the per capita costs of care for an aging population (Berwick, Nolan, and Whittington 2008), the field of health services research has grown to help policy makers and health system managers to meet this challenge. Altogether, Americans spent 3.3trillionor3.3 trillion or 3.3trillionor10,348 per person, on health care in 2016 (Centers for Medicare & Medicaid Services 2017). What did we get for all of those resources, and how can we get better results in the future? Now more than ever, decision makers around the world need the best evidence about "what works" to inform policy and practice, as we strive to make our health care systems achieve their full potential for optimizing population health. The last five years have brought dramatic growth to the field of health services research and to this journal, which represents our field. In a recent presentation at the AcademyHealth Annual Research Meeting, Bianca Frogner reported that the estimated population of active health services researchers in the United States rose from 11,596 in 2007 to 14,526-16,743 in 2015, an increase of 25-44 percent (AcademyHealth 2017). Similarly, the number of manuscripts submitted to HSR rose from 570 in 2011 to 955 in 2016, and perhaps even more in 2017. Our impact factor, based on how many times the average paper is cited in the subsequent two calendar years, rose from 2.16 in 2011 to 3.09 in 2016. The number of articles downloaded increased from about 200,000 in 2009 to 322,950 in 2016. Through these years, however, HSR as a journal has changed very little. The time has come for us to take a new look at HSR, reimagining and redesigning it to meet the needs of a new era.

Medical Care, 2000

Assurance that the content of the manuscript has not been published previously in print or elec... more Assurance that the content of the manuscript has not been published previously in print or electronic format and is not under consideration by another publication or electronic medium. The acknowledgments should indicate if the data in the manuscript have been presented at a meeting. Authors ...

American Journal of Preventive Medicine, Dec 1, 2018

The California Tobacco Control Program is the longest standing, publicly funded tobacco control p... more The California Tobacco Control Program is the longest standing, publicly funded tobacco control program in the U.S. California's adult smoking rate declined from 23.7% (1989) to 11% (2016) but California still has more than 3 million smokers dispersed over 58 counties, requiring a coordinated approach to further tobacco control. Early California Tobacco Control Program success is rooted in public health policy strategies and a statewide media campaign that shifted social norms. In 2009, concepts for a coordinated approach were introduced by the California Tobacco Control Program in the state's first tobacco quit plan. The state quit plan called for public health's tobacco control programs to engage healthcare systems and insurers to work more directly with the California Smoker's Helpline (Helpline). With California's Medicaid (Medi-Cal) program expansion and the implementation of electronic medical record systems, health care plans and providers received additional support for system changes. Simultaneous with these changes, coordinated tobacco control efforts began, including California's MediCal Incentives to Quit Smoking project (2012 −2015). In the MediCal Incentives to Quit Smoking project, safety-net providers and MediCal plans were outreached and engaged to promote incentives for MediCal members to utilize Helpline services. In another effort, UC Quits (2013−2015), the five University of California health systems used electronic medical record tools to promote tobacco treatments and electronic referrals to the Helpline. Now, as tobacco prevention is increasingly prioritized for quality improvement, California Tobacco Control Program is funding CA Quits, a statewide tobacco-cessation learning collaborative and technical assistance resource to promote integration of tobacco treatment services and quality improvement activities into safety-net health systems. CA Quits, in coordination with the Helpline, will connect public health departments, MediCal plans, and safety-net providers to accelerate health systems change for tobacco-cessation treatment throughout the state. Supplement information: This article is part of a supplement entitled Advancing Smoking Cessation in California's Medicaid Population, which is sponsored by the California Department of Public Health.

Quality Management in Health Care, 2015

Children in rural areas face higher rates of obesity than children in urban areas, and their clin... more Children in rural areas face higher rates of obesity than children in urban areas, and their clinicians face challenges with preventing and managing obesity and translation of evidence into practice. We evaluated how the quality improvement (QI) intervention, Healthy Eating Active Living TeleHealth Community of Practice (HEALTH COP), at 7 rural California clinics addressed these challenges. Focus group interviews with QI team members assessed their experiences and factors related to adoption of key changes. Key challenges were clinician and staff buy-in, changing ingrained clinical practices, and motivating patient and families. Facilitators were top-down organizational requirements for QI, linkages to local QI resources, involvement of clinical champions, alignment with existing practices, incorporating a learning system connecting similar clinics, and clear and consistent communication channels. Evaluations of QI interventions should include not only measurement of effectiveness but also identification of factors associated with change and interactions with organizational processes and contexts.

Annals of Internal Medicine, May 2, 2000

Social Science Research Network, 2010

FTC Bureau of Economics working papers are preliminary materials circulated to stimulate discussi... more FTC Bureau of Economics working papers are preliminary materials circulated to stimulate discussion and critical comment. The analyses and conclusions set forth are those of the authors and do not necessarily reflect the views of other members of the Bureau of Economics, other Commission staff, or the Commission itself. Upon request, single copies of the paper will be provided. References in publications to FTC Bureau of Economics working papers by FTC economists (other than acknowledgment by a writer that he has access to such unpublished materials) should be cleared with the author to protect the tentative character of these papers.

International journal of health care finance and economics, Jun 1, 2004

The literature on hospital competition and quality is young; most empirical studies have focused ... more The literature on hospital competition and quality is young; most empirical studies have focused on few conditions and outcomes. Measures of in-hospital mortality and complications are susceptible to bias from unmeasured severity and transfer/discharge practices. Only one research team has evaluated related process and outcome measures, and none has exploited chart-review or patient survey-based data. Prior studies have generated inconsistent findings, suggesting the need for additional research. We describe the strengths and limitations of various approaches to quality measurement, summarize how quality has been operationalized in studies of hospital competition, outline three mechanisms by which competition may affect hospital quality, and propose measures appropriate for testing each mechanism.

Wiley StatsRef: Statistics Reference Online, Jun 22, 2015

Stability across time is one of the important components in Data Quality Assurance Process. This ... more Stability across time is one of the important components in Data Quality Assurance Process. This paper talks about a SAS® macro that has been designed to automate testing of stability across time as part of a larger data quality application package. Outlier analysis has been used for identifying unusual changes over time within large health administrative databases. The macro chooses the most appropriate model for smoothing the data curve/line. Potential outliers will be flagged on the scatterplot as suspicious points. Results will be presented only in a graphic format to be included in a Data Quality Report.

Medical Care, Nov 1, 2001

Stage at diagnosis has been used to compare the quality of cancer screening services by health in... more Stage at diagnosis has been used to compare the quality of cancer screening services by health insurance type, using membership at diagnosis or treatment. This study evaluates breast cancer stage among women on Medi-Cal, California's Medicaid program, in relation to duration of coverage to assess the impact of including women with recently acquired benefits in the Medi-Cal group. Breast cancers diagnosed in 1993 among women ages 30 to 64 were obtained from the statewide, population-based cancer registry and linked to Medi-Cal enrollment files. Women on Medi-Cal when diagnosed were categorized based on months covered during the 12 months preceding diagnosis (12, 1-11, or none), and compared with all other women with breast cancer. Logistic regression models measured the effect of duration of Medi-Cal coverage on the odds of late-stage disease, controlling for demographic, socioeconomic, health access, and tumor characteristics. Among women with Medi-Cal benefits when diagnosed, 18% were not covered during the year preceding diagnosis, and late-stage disease was common among these women. The odds ratio for late-stage disease among all women on Medi-Cal was 1.67 (95% CI 1.41, 1.97), but was reduced by 42% to 1.39 (95% CI 1.15, 1.67) when women without benefits before diagnosis were excluded from the Medi-Cal group. Women with Medi-Cal benefits before diagnosis were more likely to be diagnosed with late-stage disease than other women with breast cancer. However, the practice of assigning health insurance status based on enrollment at diagnosis underestimates the effect of access to breast cancer screening through Medicaid.

Medical care review, Dec 1, 1993

1. Med Care Rev. 1993 Winter;50(4):451-77. Can administrative data be used to compare the quality... more 1. Med Care Rev. 1993 Winter;50(4):451-77. Can administrative data be used to compare the quality of health care? Romano PS. Department of Medicine, University of California, Sacramento 95817. PMID: 10131116 [PubMed - indexed for MEDLINE]. Publication Types: ...

The New England Journal of Medicine, Jul 21, 2005

Editorial from The New England Journal of Medicine — Improving the Quality of Hospital Care in Am... more Editorial from The New England Journal of Medicine — Improving the Quality of Hospital Care in America.

Journal of Clinical Epidemiology, Mar 1, 1994

Health Services Research, Nov 27, 2016

In this issue of Health Services Research, we are pleased to publish the fifth installment of our... more In this issue of Health Services Research, we are pleased to publish the fifth installment of our featured section, "The Best of the 2016 AcademyHealth Annual Research Meeting (ARM)". We publish annually a set of articles based on abstracts submitted to the ARM and selected to be outstanding by both reviewers from the ARM themes and HSR's own editorial staff and reviewers. Health Services Research has been an official journal of AcademyHealth for many years, and this relatively new feature is the latest in a string of successful collaborative efforts intended to showcase significant work in the field of health services research in a timely manner. Early in 2016, we requested from AcademyHealth staff members the highest scoring abstracts from each of the ARM themes whose authors had indicated an interest in "Best of ARM" publication. From approximately 75 abstracts, the editors of HSR invited 18 authors to submit a full manuscript for consideration for publication. The submitted manuscripts went through expedited review, culminating in the seven articles appearing in this issue. Several papers in this issue of HSR explore key questions related to health reform. The appropriateness of hospital admissions and readmissions was addressed from several perspectives. Lammers, McLaughlin, and Barna (2016) investigated the relationship between ambulatory physcians' use of electronic health records (EHR) and hospital admissions and readmissions for four common ambulatory care-sensitive conditions (ACSC). Their findings imply that 26,689 fewer ACSC admissions from 2010 to 2013 were related to EHR adoption. However, they found no correlation between EHR use and readmissions. Rahman et al. (2016) were interested in the validity of a skilled nursing facility's (SNF) rehospitalization rate as a quality measure. Using instrumental variables, they found that treatment in SNFs

Archives of internal medicine, Nov 25, 1996

Medical Care, Oct 1, 2018

Background: Routinely collected hospital data provide increasing opportunities to assess the perf... more Background: Routinely collected hospital data provide increasing opportunities to assess the performance of health care systems. Several factors may, however, influence performance measures and their interpretation between countries. Objective: We compared the occurrence of in-hospital venous thromboembolism (VTE) in patients undergoing hip replacement across 5 countries and explored factors that could explain differences across these countries. Methods: We performed cross-sectional studies independently in 5 countries: Canada; France; New Zealand; the state of California; and Switzerland. We first calculated the proportion of hospital inpatients with at least one deep vein thrombosis (DVT) or pulmonary embolism by using numerator codes from the corresponding Patient Safety Indicator. We then compared estimates from each country against a reference value (benchmark) that displayed the baseline risk of VTE in such patients. Finally, we explored length of stay, number of secondary diagnoses coded, and systematic use of ultrasound to detect DVT as potential factors that could explain between-country differences. Results: The rates of VTE were 0.16% in Canada, 1.41% in France, 0.84% in New Zealand, 0.66% in California, and 0.37% in Switzerland, while the benchmark was 0.58% (95% confidence interval, 0.35-0.81). Factors that could partially explain differences in VTE rates between countries were hospital length of stay, number of secondary diagnoses coded, and proportion of patients who received lower limb ultrasound to screen for DVT systematically before hospital discharge. An exploration of the French data showed that the systematic use of ultrasound may be associated with over detection of DVT but not pulmonary embolism. Conclusions: In-hospital VTE rates after arthroplasty vary widely across countries, and a combination of clinical, data-related, and health system factors explain some of the variations in VTE rates across countries.

The Cost of Birth Defects: Estimates of the Value of Protection WAITZMAN Norman J., SCHEFFLER Ric... more The Cost of Birth Defects: Estimates of the Value of Protection WAITZMAN Norman J., SCHEFFLER Richard M., ROMANO Patrick S.

International Journal for Quality in Health Care, Jun 4, 2015

Purpose: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital da... more Purpose: To develop a consensus opinion regarding capturing diagnosis-timing in coded hospital data. Methods: As part of the World Health Organization International Classification of Diseases-11th Revision initiative, the Quality and Safety Topic Advisory Group is charged with enhancing the capture of quality and patient safety information in morbidity data sets. One such feature is a diagnosis-timing flag. The Group has undertaken a narrative literature review, scanned national experiences focusing on countries currently using timing flags, and held a series of meetings to derive formal recommendations regarding diagnosis-timing reporting. Results: The completeness of diagnosis-timing reporting continues to improve with experience and use; studies indicate that it enhances risk-adjustment and may have a substantial impact on hospital performance estimates, especially for conditions/procedures that involve acutely ill patients. However, studies suggest that its reliability varies, is better for surgical than medical patients (kappa in hip fracture patients of 0.7-1.0 versus kappa in pneumonia of 0.2-0.6) and is dependent on coder training and setting. It may allow simpler and more precise specification of quality indicators. Conclusions: As the evidence indicates that a diagnosis-timing flag improves the ability of routinely collected, coded hospital data to support outcomes research and the development of quality and safety indicators, the Group recommends that a classification of 'arising after admission' (yes/no), with permitted designations of 'unknown or clinically undetermined', will facilitate coding while providing flexibility when there is uncertainty. Clear coding standards and guidelines with ongoing coder education will be necessary to ensure reliability of the diagnosis-timing flag.

PubMed, Mar 1, 2000

Although we disagree with Dr. Romano's decision to exclude all con-ditions diagnosed after a... more Although we disagree with Dr. Romano's decision to exclude all con-ditions diagnosed after admission, we view his article as providing the reader with an excellent springboard for further discussion of issues pertaining to risk adjustment and complications. In this response to ...