Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act

Huntoon, Kristin; McCluney, Colin J.; Scannell, Christopher A.; Wiley, Elizabeth; Bruno, Richard L.; Andrews, Allen H.; Gorman, Paul N.

doi:10.1371/journal.pone.0023557

Cited by 26 publications

(27 citation statements)

References 11 publications

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“…However, most would agree that health policy education in North American medical schools is poor. 5,6,16,17 In our study, only one-third of all respondents demonstrated accurate knowledge of the basics of their own health care system, and fewer than 1 in 10 respondents understood the basics of the 18 A large majority of respondents in both locations rated the quantity of instruction on health care policy as too little, and a minority rated the quality as good or excellent. The medical curriculum ranked low as a source of information.…”

Section: Comparison With Other Studiescontrasting

confidence: 62%

Attitudes and knowledge regarding health care policy and systems: a survey of medical students in Ontario and California

et al. 2014

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Section: Comparison With Other Studiescontrasting

confidence: 62%

Attitudes and knowledge regarding health care policy and systems: a survey of medical students in Ontario and California

et al. 2014

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“…In addition, our response rate is significantly higher than those in previous studies that attempted to characterize students' views regarding the ACA. 34 The majority of medical students in this study indicated both support for the ACA and a professional obligation to assist with its implementation. Medical student support for the ACA, particularly among medical students who anticipate a medical specialty, indicates that future physicians are willing to engage with legislation that aims to improve access to care and increase the primary care workforce.…”

Section: Discussionmentioning

confidence: 72%

Medical Students’ Views and Knowledge of the Affordable Care Act: A Survey of Eight U.S. Medical Schools

et al. 2015

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BACKGROUND:It is not known whether medical students support the Affordable Care Act (ACA) or possess the knowledge or will to engage in its implementation as part of their professional obligations. OBJECTIVE: To characterize medical students' views and knowledge of the ACA and to assess correlates of these views. DESIGN: Cross-sectional email survey. PARTICIPANTS: All 5,340 medical students enrolled at eight geographically diverse U.S. medical schools (overall response rate 52 % [2,761/5,340]). MAIN MEASURES: Level of agreement with four questions regarding views of the ACA and responses to nine knowledge-based questions. KEY RESULTS: The majority of respondents indicated an understanding of (75.3 %) and support for (62.8 %) the ACA and a professional obligation to assist with its implementation (56.1 %). The mean knowledge score from nine knowledge-based questions was 6.9±1.3. Students anticipating a surgical specialty or procedural specialty compared to those anticipating a medical specialty were less likely to support the legislation (OR=0. 6 CONCLUSIONS:The majority of students in our sample support the ACA. Support was highest among students who anticipate a medical specialty, self-identify as political moderates or liberals, and have an above-average knowledge score. Support of the ACA by future physicians suggests that they are willing to engage with health care reform measures that increase access to care.

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“…In this environment, "value-based" reforms are being adopted by most stakeholders to help achieve sustainability of the current US health care system. 6,12,30,[33][34][35]37 Safety, effectiveness, patient-experience, and cost of care are the central components of the health care value equation. The value of medical services is generally described at both population and individual levels.…”

mentioning

confidence: 99%

Inadequacy of 3-month Oswestry Disability Index outcome for assessing individual longer-term patient experience after lumbar spine surgery

Asher

Chotai

Devin

et al. 2016

SPI

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OBJECTIVE Prospective longitudinal outcomes registries are at the center of evidence-driven health care reform. Obtaining real-world outcomes data at 12 months can be costly and challenging. In the present study, the authors analyzed whether 3-month outcome measurements sufficiently represent 12-month outcomes for patients with degenerative lumbar disease undergoing surgery. METHODS Data from 3073 patients undergoing elective spine surgery for degenerative lumbar disease were entered into a prospective multicenter registry (N2QOD). Baseline, 3-month, and 12-month follow-up Oswestry Disability Index (ODI) scores were recorded. The absolute differences between actual 12- and 3-month ODI scores was evaluated. Additionally, the authors analyzed the absolute difference between actual 12-month ODI scores and a model-predicted 12-month ODI score (the model used patients' baseline characteristics and actual 3-month scores). The minimal clinically important difference (MCID) for ODI of 12.8 points and the substantial clinical benefit (SCB) for ODI of 18.8 points were used based on the previously published values. The concordance rate of achieving MCID and SCB for ODI at 3-and 12-months was computed. RESULTS The 3-month ODI scores differed from 12-month scores by an absolute difference of 11.9 ± 10.8, and predictive modeling estimations of 12-month ODI scores differed from actual 12-month scores by a mean (± SD) of 10.7 ± 9.0 points (p = 0.001). Sixty-four percent of patients (n = 1982) achieved an MCID for ODI at 3 months in comparison with 67% of patients (n = 2088) by 12 months; 51% (n = 1731) and 61% (n = 1860) of patients achieved SCB for ODI at 3 months and 12 months, respectively. Almost 20% of patients had ODI scores that varied at least 20 points (the point span of an ODI functional category) between actual 3- and 12-month values. In the aggregate analysis of achieving MCID, 77% of patients were concordant and 23% were discordant in achieving or not achieving MCID at 3 and 12 months. The discordance rates of achieving or not achieving MCID for ODI were in the range of 19% to 27% for all diagnoses and treatments (decompression with and without fusion). The positive and negative predictive value of 3-months ODI to predict 12-month ODI was 86% and 60% for MCID and 82% and 67% for SCB. CONCLUSIONS Based on their findings, the authors conclude the following: 1) Predictive methods for functional outcome based on early patient experience (i.e., baseline and/or 3-month data) should be used to help evaluate the effectiveness of procedures in patient populations, rather than serving as a proxy for long-term individual patient experience. 2) Prospective longitudinal registries need to span at least 12 months to determine the effectiveness of spine care at the individual patient and practitioner level.

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Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act

Cited by 26 publications

References 11 publications

Attitudes and knowledge regarding health care policy and systems: a survey of medical students in Ontario and California

Attitudes and knowledge regarding health care policy and systems: a survey of medical students in Ontario and California

Medical Students’ Views and Knowledge of the Affordable Care Act: A Survey of Eight U.S. Medical Schools

Inadequacy of 3-month Oswestry Disability Index outcome for assessing individual longer-term patient experience after lumbar spine surgery

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