Objective. To compare the relative trustworthiness of nonprofit and for-profit health plans, using physician assessments to measure dimensions of plan performance that are difficult for consumers to evaluate. Data Source. A nationally representative sample of 1,621 physicians who responded to a special topics module of the 1998 Socioeconomic Monitoring System Survey (SMS), fielded by the American Medical Association. Physicians assessed various aspects of their primary managed care plan, defined as the plan in which they had the largest number of patients. Study Design. Plan ownership was measured as the interaction of tax-exempt status (nonprofit versus for-profit) and corporate control (single state versus multistate health plans). Two sets of regression models are estimated. The dependent variables in the regressions are five measures of performance related to plan trustworthiness: two related to deceptive practices and three to dimensions of quality that are largely hidden from enrollees. The first set (baseline) models relate plan ownership to trustworthy practices, controlling for other characteristics of the plan, the marketplace for health insurance, and the physician respondents. The second (interactive) set of models examines how the magnitude of ownership-related differences in trustworthiness varies with the market share of nonprofit plans in each community. Data Collection. The 1998 SMS was fielded between April and September of 1998 by Westat Inc. The average time required for a completed interview was approximately 30 minutes. The overall response rate was 52.2 percent. Principal Findings. Compared with more local nonprofit plans, for-profit plans affiliated with multistate corporations are consistently reported by their affiliated physicians to engage in practices associated with reduced trustworthiness. Nonprofit plans affiliated with multistate corporations have more physician-reported practices associated with trustworthiness than do for-profit corporate plans on four of five outcomes, but appear less trustworthy than locally controlled nonprofits on two of the five measures. The magnitude of these ownership-related differences declines as the market share of 605

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Atrial fibrillation (AF) afflicts nearly 3 million people in the United States annually, the large majority of whom are Medicare beneficiaries with other chronic illnesses. Beneficiaries with multiple chronic conditions have high hospitalization and readmission rates but evidence on factors associated with readmissions is limited, and little is known about differences in rates between beneficiaries with and without AF. In a retrospective analysis of Medicare claims data, the relationship between outpatient visits within 14 days after hospital discharge and readmission was examined for beneficiaries with AF or other chronic conditions. About half of those beneficiaries with a hospitalization had an outpatient visit within 14 days of discharge. Readmission rates were 11% to 24% lower for beneficiaries with an outpatient visit than for those without one (P < .01). These findings suggest that follow-up care shortly after discharge may lower readmissions for patients with AF or other chronic conditions.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a concerning epidemic, and sub-optimal glycemic control could lead to higher risk of complications and needs for additional care. Hypertension and obesity are common comorbid conditions, yet their impact on glycemic control has not been quantified. We hypothesize that comorbid hypertension and/or obesity are associated with a higher likelihood of uncontrolled glycemic level. METHODS: Data from a nationally representative sample of US population participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2010 were analyzed in a cross-sectional retrospective observational study. Adults aged 20 years or older with self-reported diabetes and anti-diabetes medication use were included. Pregnant women were excluded. T2DM was defined by excluding diabetes patients who were diagnosed before age 30 and took only insulin. Uncontrolled hypertension was defined as blood pressure of ≥130 mmHg (systolic) or ≥80 mmHg (diastolic) based on American Diabetes Association’s guidance for hypertension in diabetes patients. Obesity was determined if body mass index ≥30 kg/m 2 . Uncontrolled glycemic level was defined as HbA1c ≥7%. We estimated the prevalence of uncontrolled hypertension and obesity among T2DM patients. Rates of uncontrolled glycemic level were reported and compared by uncontrolled hypertension and/or obesity status using Chi-square tests. Population weights were applied to account for multi-stage sampling design to produce nationally representative estimates. RESULTS: After applying the population weights to the 2,203 respondents with T2DM, findings from these respondents were extrapolated to an estimated 15.4 million T2DM patients in the US (prevalence of T2DM=7.4%), of which 61.1% were obese. Among US T2DM patients, the prevalence of uncontrolled hypertension was 52.6%. Among US T2DM patients, the prevalence of patients who had uncontrolled hypertension and who were obese was 31.2%. No statistically significant differences were found in uncontrolled glycemic level rates between those with and without uncontrolled hypertension (44.0% vs. 41.0%; p=0.31). Obese patients had a statistically significant higher rate of uncontrolled glycemic level than non-obese (44.5% vs. 37.9%; p=0.03). T2DM patients with comorbid uncontrolled hypertension and obesity had a statistically significant higher rate of uncontrolled glycemic level than the rest of the T2DM patients (47.1% vs. 40.0%; p=0.02). CONCLUSIONS: Prevalence of uncontrolled hypertension and obesity was high in US adults with T2DM. Obese patients, especially those who had uncontrolled blood pressure, had sub-optimal glycemic control. Interventions targeting these patients should be considered.