Haya Rubin | Stanford University (original) (raw)

Papers by Haya Rubin

Research paper thumbnail of Is physician self-disclosure related to patient evaluation of office visits?

Journal of General Internal Medicine, Sep 1, 2004

Research paper thumbnail of Overcoming barriers to preventive care

Journal of General Internal Medicine, Jun 1, 2000

Research paper thumbnail of Diphenhydramine in infants. Authors' reply

Archives of Pediatrics Adolescent Medicine, 2007

Research paper thumbnail of Reliability of medical audit in quality assessment of medical care

Cadernos de Saúde Pública, 1996

Medical audit of hospital records has been a major component of quality of care assessment, altho... more Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6), depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-orie...

Research paper thumbnail of Conceptual Framework for a New Tool for Evaluating the Quality of Diabetes Consumer-Information Web Sites

Journal of Medical Internet Research, 2003

Research paper thumbnail of Overcoming barriers to preventive care

Journal of General Internal Medicine, 2000

Research paper thumbnail of Interventions to Prevent Readmission for Congestive Heart Failure

Research paper thumbnail of The advantages and disadvantages of process-based measures of health care quality

International Journal for Quality in Health Care, 2001

Research paper thumbnail of Methodology Matters. From a process of care to a measure: the development and testing of a quality indicator

International Journal for Quality in Health Care, 2001

Research paper thumbnail of The Appropriateness of Coronary Artery Bypass Graft Surgery in Academic Medical Centers

Annals of Internal Medicine, 1996

Research paper thumbnail of Is Health Plan Employer Data and Information Set Performance Associated With Withdrawal From Medicare Managed Care?

Medical Care, Mar 1, 2002

Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some... more Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some plans claim that providing higher quality care raises costs, lowers profits, and spurs withdrawal because plans cannot sustain high quality care under current payment levels. To assess whether higher performance by Medicare health plans on quality indicators was associated with withdrawal. Retrospective cohort study. Taking each county where a contract was active as a unit of analysis, Medicare managed care plans active in 2310 contract-county combinations in 1997 were studied and followed for 3 years. Independent variables were scores on six indicators from the Health Plan Employer Data and Information Set (HEDIS) for each contract, collapsed into two summary measures: clinical and ambulatory care access. Separate Cox proportional hazards regressions were used for each indicator, and each summary measure, to assess the association of HEDIS performance with our outcome measure, time-to-withdrawal from Medicare. Multiple potential confounders were adjusted for. Of 2310 managed care contract-county combinations, 877 (38%) withdrew. The proportion of contract-counties with high scores on the summary clinical quality measure that withdrew was one-fifth that for low scorers (4.2% vs. 20.5%). For summary ambulatory care access performance, the corresponding ratio was two-fifths (12.8% vs. 32.0%). Lower payments were associated with higher withdrawal risk, but also higher clinical and ambulatory care access quality performance. In separate multivariable analyses controlling for confounders, both high clinical performance (HR, 0.18; 95% CI, 0.08-0.42) and high ambulatory care access performance (HR, 0.53; 95% CI, 0.27-1.07) were independently associated with lower withdrawal risk. Health plans continuing to provide care to Medicare beneficiaries have higher average performance on HEDIS clinical and ambulatory care access measures than plans that withdrew.

Research paper thumbnail of Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement

Pediatric Research, Apr 1, 1999

Research paper thumbnail of Are Critical Pathways Effective for Reducing Postoperative Length of Stay?

Medical Care, May 1, 2003

Research paper thumbnail of Critical Pathway Effectiveness: Assessing the Impact of Patient, Hospital Care, and Pathway Characteristics Using Qualitative Comparative Analysis

Health Services Research, Mar 10, 2005

Research paper thumbnail of RESEARCH BRIEF Research and Methods Briefs Does the Frequency of Pay-for-Performance Payment Matter?——Experience from a Randomized Trial

Objective. To examine the effects of incentive payment frequency on quality mea-sures in a physic... more Objective. To examine the effects of incentive payment frequency on quality mea-sures in a physician-specific pay-for-performance (P4P) experiment. Study Setting. A multispecialty physician group practice. Study Design. In 2007, all primary care physicians (n5 179) were randomized into two study arms differing by the frequency of incentive payment, either four quarterly bonus checks or a single year-end bonus (maximum of U.S.$5,000/year for both arms). Data Collection/Extraction Methods. Data were extracted from electronic health records. Quality measure scores between the two arms over four quarters were compared. Principal Findings. There was no difference between the two arms in average quality measure score or in total bonus amount earned. Conclusions. Physicians ’ responses to a P4P program with a small maximum bonus do not differ by frequency of bonus payment.

Research paper thumbnail of Effect of physician-specific pay-for-performance incentives in a large group practice

The American journal of managed care, 2010

To assess the effect of a physician-specific pay-for-performance program on quality-of-care measu... more To assess the effect of a physician-specific pay-for-performance program on quality-of-care measures in a large group practice. In 2007, Palo Alto Medical Clinic, a multispecialty physician group practice, changed from group-focused to physician-specific pay-for-performance incentives. Primary care physicians received incentive payments based on their quarterly assessed performance. We examined 9 reported and incentivized clinical outcome and process measures. Five reported and nonincentivized measures were used for comparison purposes. The quality score of each physician for each measure was the main dependent variable and was calculated as follows: Quality Score = (Patients Meeting Target / Eligible Patients) x 100. Differences in scores between 2006 and 2007 were compared with differences in scores between 2005 and 2006. We also compared the performance of Palo Alto Medical Clinic with that of 2 other affiliated physician groups implementing group-level incentives. Eight of 9 rep...

Research paper thumbnail of Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center

Quality and Safety in Health Care, 2003

Research paper thumbnail of Is Health Plan Employer Data and Information Set Performance Associated With Withdrawal From Medicare Managed Care?

Medical Care, 2002

Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some... more Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some plans claim that providing higher quality care raises costs, lowers profits, and spurs withdrawal because plans cannot sustain high quality care under current payment levels. To assess whether higher performance by Medicare health plans on quality indicators was associated with withdrawal. Retrospective cohort study. Taking each county where a contract was active as a unit of analysis, Medicare managed care plans active in 2310 contract-county combinations in 1997 were studied and followed for 3 years. Independent variables were scores on six indicators from the Health Plan Employer Data and Information Set (HEDIS) for each contract, collapsed into two summary measures: clinical and ambulatory care access. Separate Cox proportional hazards regressions were used for each indicator, and each summary measure, to assess the association of HEDIS performance with our outcome measure, time-to-withdrawal from Medicare. Multiple potential confounders were adjusted for. Of 2310 managed care contract-county combinations, 877 (38%) withdrew. The proportion of contract-counties with high scores on the summary clinical quality measure that withdrew was one-fifth that for low scorers (4.2% vs. 20.5%). For summary ambulatory care access performance, the corresponding ratio was two-fifths (12.8% vs. 32.0%). Lower payments were associated with higher withdrawal risk, but also higher clinical and ambulatory care access quality performance. In separate multivariable analyses controlling for confounders, both high clinical performance (HR, 0.18; 95% CI, 0.08-0.42) and high ambulatory care access performance (HR, 0.53; 95% CI, 0.27-1.07) were independently associated with lower withdrawal risk. Health plans continuing to provide care to Medicare beneficiaries have higher average performance on HEDIS clinical and ambulatory care access measures than plans that withdrew.

Research paper thumbnail of Are Critical Pathways Effective for Reducing Postoperative Length of Stay?

Research paper thumbnail of Environmental factors and quality of life among poor children with asthma*1

Journal of Allergy and Clinical Immunology, 2004

RationalePoor and minority children have greater asthma prevalence and morbidity, than their same... more RationalePoor and minority children have greater asthma prevalence and morbidity, than their same-aged counterparts in more privileged groups. This may be due in part to difficulties controlling asthma triggers at home. We measured the prevalence of asthma triggers in the homes of poor, predominately African-American children and determined if the presence of triggers was associated with low health-related quality of

Research paper thumbnail of Is physician self-disclosure related to patient evaluation of office visits?

Journal of General Internal Medicine, Sep 1, 2004

Research paper thumbnail of Overcoming barriers to preventive care

Journal of General Internal Medicine, Jun 1, 2000

Research paper thumbnail of Diphenhydramine in infants. Authors' reply

Archives of Pediatrics Adolescent Medicine, 2007

Research paper thumbnail of Reliability of medical audit in quality assessment of medical care

Cadernos de Saúde Pública, 1996

Medical audit of hospital records has been a major component of quality of care assessment, altho... more Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6), depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-orie...

Research paper thumbnail of Conceptual Framework for a New Tool for Evaluating the Quality of Diabetes Consumer-Information Web Sites

Journal of Medical Internet Research, 2003

Research paper thumbnail of Overcoming barriers to preventive care

Journal of General Internal Medicine, 2000

Research paper thumbnail of Interventions to Prevent Readmission for Congestive Heart Failure

Research paper thumbnail of The advantages and disadvantages of process-based measures of health care quality

International Journal for Quality in Health Care, 2001

Research paper thumbnail of Methodology Matters. From a process of care to a measure: the development and testing of a quality indicator

International Journal for Quality in Health Care, 2001

Research paper thumbnail of The Appropriateness of Coronary Artery Bypass Graft Surgery in Academic Medical Centers

Annals of Internal Medicine, 1996

Research paper thumbnail of Is Health Plan Employer Data and Information Set Performance Associated With Withdrawal From Medicare Managed Care?

Medical Care, Mar 1, 2002

Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some... more Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some plans claim that providing higher quality care raises costs, lowers profits, and spurs withdrawal because plans cannot sustain high quality care under current payment levels. To assess whether higher performance by Medicare health plans on quality indicators was associated with withdrawal. Retrospective cohort study. Taking each county where a contract was active as a unit of analysis, Medicare managed care plans active in 2310 contract-county combinations in 1997 were studied and followed for 3 years. Independent variables were scores on six indicators from the Health Plan Employer Data and Information Set (HEDIS) for each contract, collapsed into two summary measures: clinical and ambulatory care access. Separate Cox proportional hazards regressions were used for each indicator, and each summary measure, to assess the association of HEDIS performance with our outcome measure, time-to-withdrawal from Medicare. Multiple potential confounders were adjusted for. Of 2310 managed care contract-county combinations, 877 (38%) withdrew. The proportion of contract-counties with high scores on the summary clinical quality measure that withdrew was one-fifth that for low scorers (4.2% vs. 20.5%). For summary ambulatory care access performance, the corresponding ratio was two-fifths (12.8% vs. 32.0%). Lower payments were associated with higher withdrawal risk, but also higher clinical and ambulatory care access quality performance. In separate multivariable analyses controlling for confounders, both high clinical performance (HR, 0.18; 95% CI, 0.08-0.42) and high ambulatory care access performance (HR, 0.53; 95% CI, 0.27-1.07) were independently associated with lower withdrawal risk. Health plans continuing to provide care to Medicare beneficiaries have higher average performance on HEDIS clinical and ambulatory care access measures than plans that withdrew.

Research paper thumbnail of Why Don't Physicians Follow Clinical Practice Guidelines? A Framework for Improvement

Pediatric Research, Apr 1, 1999

Research paper thumbnail of Are Critical Pathways Effective for Reducing Postoperative Length of Stay?

Medical Care, May 1, 2003

Research paper thumbnail of Critical Pathway Effectiveness: Assessing the Impact of Patient, Hospital Care, and Pathway Characteristics Using Qualitative Comparative Analysis

Health Services Research, Mar 10, 2005

Research paper thumbnail of RESEARCH BRIEF Research and Methods Briefs Does the Frequency of Pay-for-Performance Payment Matter?——Experience from a Randomized Trial

Objective. To examine the effects of incentive payment frequency on quality mea-sures in a physic... more Objective. To examine the effects of incentive payment frequency on quality mea-sures in a physician-specific pay-for-performance (P4P) experiment. Study Setting. A multispecialty physician group practice. Study Design. In 2007, all primary care physicians (n5 179) were randomized into two study arms differing by the frequency of incentive payment, either four quarterly bonus checks or a single year-end bonus (maximum of U.S.$5,000/year for both arms). Data Collection/Extraction Methods. Data were extracted from electronic health records. Quality measure scores between the two arms over four quarters were compared. Principal Findings. There was no difference between the two arms in average quality measure score or in total bonus amount earned. Conclusions. Physicians ’ responses to a P4P program with a small maximum bonus do not differ by frequency of bonus payment.

Research paper thumbnail of Effect of physician-specific pay-for-performance incentives in a large group practice

The American journal of managed care, 2010

To assess the effect of a physician-specific pay-for-performance program on quality-of-care measu... more To assess the effect of a physician-specific pay-for-performance program on quality-of-care measures in a large group practice. In 2007, Palo Alto Medical Clinic, a multispecialty physician group practice, changed from group-focused to physician-specific pay-for-performance incentives. Primary care physicians received incentive payments based on their quarterly assessed performance. We examined 9 reported and incentivized clinical outcome and process measures. Five reported and nonincentivized measures were used for comparison purposes. The quality score of each physician for each measure was the main dependent variable and was calculated as follows: Quality Score = (Patients Meeting Target / Eligible Patients) x 100. Differences in scores between 2006 and 2007 were compared with differences in scores between 2005 and 2006. We also compared the performance of Palo Alto Medical Clinic with that of 2 other affiliated physician groups implementing group-level incentives. Eight of 9 rep...

Research paper thumbnail of Evaluation of the culture of safety: survey of clinicians and managers in an academic medical center

Quality and Safety in Health Care, 2003

Research paper thumbnail of Is Health Plan Employer Data and Information Set Performance Associated With Withdrawal From Medicare Managed Care?

Medical Care, 2002

Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some... more Withdrawals of health plans from Medicare have affected more than 1.6 million beneficiaries. Some plans claim that providing higher quality care raises costs, lowers profits, and spurs withdrawal because plans cannot sustain high quality care under current payment levels. To assess whether higher performance by Medicare health plans on quality indicators was associated with withdrawal. Retrospective cohort study. Taking each county where a contract was active as a unit of analysis, Medicare managed care plans active in 2310 contract-county combinations in 1997 were studied and followed for 3 years. Independent variables were scores on six indicators from the Health Plan Employer Data and Information Set (HEDIS) for each contract, collapsed into two summary measures: clinical and ambulatory care access. Separate Cox proportional hazards regressions were used for each indicator, and each summary measure, to assess the association of HEDIS performance with our outcome measure, time-to-withdrawal from Medicare. Multiple potential confounders were adjusted for. Of 2310 managed care contract-county combinations, 877 (38%) withdrew. The proportion of contract-counties with high scores on the summary clinical quality measure that withdrew was one-fifth that for low scorers (4.2% vs. 20.5%). For summary ambulatory care access performance, the corresponding ratio was two-fifths (12.8% vs. 32.0%). Lower payments were associated with higher withdrawal risk, but also higher clinical and ambulatory care access quality performance. In separate multivariable analyses controlling for confounders, both high clinical performance (HR, 0.18; 95% CI, 0.08-0.42) and high ambulatory care access performance (HR, 0.53; 95% CI, 0.27-1.07) were independently associated with lower withdrawal risk. Health plans continuing to provide care to Medicare beneficiaries have higher average performance on HEDIS clinical and ambulatory care access measures than plans that withdrew.

Research paper thumbnail of Are Critical Pathways Effective for Reducing Postoperative Length of Stay?

Research paper thumbnail of Environmental factors and quality of life among poor children with asthma*1

Journal of Allergy and Clinical Immunology, 2004

RationalePoor and minority children have greater asthma prevalence and morbidity, than their same... more RationalePoor and minority children have greater asthma prevalence and morbidity, than their same-aged counterparts in more privileged groups. This may be due in part to difficulties controlling asthma triggers at home. We measured the prevalence of asthma triggers in the homes of poor, predominately African-American children and determined if the presence of triggers was associated with low health-related quality of