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Cesarean delivery is the most commonly performed surgical procedure in the United States, and cesarean rates are increasing. Working with 2009 data from 593 US hospitals nationwide, we found that cesarean rates varied tenfold across hospitals, from 7.1 percent to 69.9 percent. Even for women with lower-risk pregnancies, in which more limited variation might be expected, cesarean rates varied fifteen-fold, from 2.4 percent to 36.5 percent. Thus, vast differences in practice patterns are likely to be driving the costly overuse of cesarean delivery in many US hospitals. Because Medicaid pays for nearly half of US births, government efforts to decrease variation are warranted. We focus on four promising directions for reducing these variations, including better coordination of maternity care, more data collection and measurement, tying Medicaid payment to quality improvement, and enhancing patient-centered decision making through public reporting.

The economic benefits of daily migraine prevention have been subject to ongoing debate. This study was undertaken to determine if the initiation of prevention had an observable effect on ambulatory health care utilisation when compared to acute migraine treatment alone. Administrative claims data from the Military Health System were used to conduct a retrospective, longitudinal cohort study of 3762 patients with migraine. New users of daily migraine prevention were matched to a reference group of non-users using propensity score methods. This matched sample then was used to evaluate the effect of prevention on ambulatory health care expenditures. The study results showed that exposure to daily migraine prevention led to lower rates of utilisation relative to what new patients would have consumed in the absence of treatment. The results suggest that additional economic benefits could be realised by increasing the appropriate use of daily migraine prevention.

Continuity of care (CoC) is a cornerstone of the patient-centered medical home (PCMH) and one of the primary means for achieving health care quality. Despite decades of study, however, CoC remains difficult to define and quantify. To incorporate patient experiences into health reform evaluations, it is critical to determine if and how well CoC measures traditionally derived from administrative claims capture patient experiences. In this study, we used claims data and self-reported continuity experiences of 2,620 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire to compare 16 claims-based CoC indices to a multidimensional patient-reported CoC measure. Our results show that most claims-based CoC measures do not reflect older adults' perceptions of continuous patient–provider relationships, indicating that claims-based assessments should be used in tandem with patient reports for defining, quantifying, and evaluating CoC in health care delivery models.