Research has shown a meaningful interaction between expectancy and task value, although the interaction has not been examined in academic functioning other than achievement and behavioral engagement. ...This study aimed to systematically test the effect of the interaction on various academic outcomes including effort, achievement, test anxiety, and cognitive strategy uses (rehearsal, elaboration, and organization). We used the Korean Educational Longitudinal Study 2005 database, which includes data for 6629 ninth-grade students. First, a compensatory effect appeared with rehearsal for intrinsic value, but no significant interaction was found for elaboration and organization for intrinsic and utility values. Second, regardless of value type, a buffering effect emerged with test anxiety. Last, in contrast with previous studies, no synergistic effect was found on effort and achievement. These findings suggest the importance of boosting expectancy beliefs and task values and offer a cautionary message to educators regarding stressing task values, especially among less competent students, because the benefit seems restricted.
•The patterns of interaction between expectancy and value can vary beyond synergistic effect.•A compensatory effect between expectancy and intrinsic value appeared for rehearsal.•No significant interaction between expectancy and the two values was found on elaboration and organization.•A buffering effect between expectancy and the two values appeared for test anxiety.•No synergistic effect between expectancy and the two values was found on effort and achievement.
Abstract Purpose Continuity of care is a defining characteristic of primary care associated with lower costs and improved health equity and care quality. However, we lack provider-level measures of ...primary care continuity amenable to value-based payment, including the Medicare Quality Payment Program (QPP). We created 4 physician-level, claims-based continuity measures and tested their associations with health care expenditures and hospitalizations. Methods We used Medicare claims data for 1,448,952 beneficiaries obtaining care from a nationally representative sample of 6,551 primary care physicians to calculate continuity scores by 4 established methods. Patient-level continuity scores attributed to a single physician were averaged to create physician-level scores. We used beneficiary multilevel models, including beneficiary controls, physician characteristics, and practice rurality to estimate associations with total Medicare Part A & B expenditures (allowed charges, logged), and any hospitalization. Results Our continuity measures were highly correlated (correlation coefficients ranged from 0.86 to 0.99), with greater continuity associated with similar outcomes for each. Adjusted expenditures for beneficiaries cared for by physicians in the highest Bice-Boxerman continuity score quintile were 14.1% lower than for those in the lowest quintile ($8,092 vs $6,958; β = −0.151; 95% CI, −0.186 to −0.116), and the odds of hospitalization were 16.1% lower between the highest and lowest continuity quintiles (OR = 0.839; 95% CI, 0.787 to 0.893). Conclusions All 4 continuity scores tested were significantly associated with lower total expenditures and hospitalization rates. Such indices are potentially useful as QPP measures, and may also serve as proxy resource-use measures, given the strength of association with lower costs and utilization.
There are ongoing efforts to understand female adolescents' motivation in math, as part of the science, technology, engineering, and math fields. The current study aimed to examine the temporal ...relations among expectancies, task values (intrinsic and utility value), and perceived costs (emotional and effort cost) in math to understand the underlying motivational processes for math-related career intention and achievement among middle school girls. To this end, we collected responses from 638 Korean middle school girls three separate times within a year. The autoregressive cross-lagged results revealed that there was no reciprocal relationship between expectancies and task values, but there appeared to be unidirectional positive prediction paths from utility value to self-efficacy. Regarding the costs, there were reciprocal relations between intrinsic value and emotional cost, which negatively affected each other. Consequently, utility value indirectly enhanced girls' math achievement by fostering self-efficacy, whereas emotional cost indirectly hindered their career intentions in math by dampening their intrinsic value. These findings suggest that it is important not only to increase task values, but also to manage costs to help adolescent girls adhere to their math-related career goals.
•Unidirectional prediction paths appeared from utility value to self-efficacy.•There were reciprocal relations between intrinsic value and emotional cost.•Intrinsic value solely predicted math-related career intention.•Self-efficacy solely predicted math achievement.•Not only the direct paths, but the indirect paths to outcomes were tested.
The Centers for Medicare & Medicaid Services (CMS) grades nursing home performance in antipsychotic prescribing quarterly, publishing findings as a quality measure. While scores have improved since ...2011, marked performance variation between facilities persists. To assess quality gap changes between best- and worst-performing deciles, we compared quarterly prescribing changes between these groups pre-pandemic (April 2011 to March 2020) and during the pandemic (April 2020 to March 2022). Antipsychotic quality measure scores, improving pre-pandemic, deteriorated during the pandemic. The pre-pandemic quality gap between the best- and worst-performing deciles narrowed as the worst-performing decile improved faster than the best-performing decile. During the pandemic, the quality gap widened as the worst-performing decile relapsed more than the best-performing decile (p < .0001). The pandemic disrupted quality performance gains and compounded disparities between facilities. A better understanding of the factors allowing high performers to weather pandemic stressors better than poor performers may reveal opportunities to improve nursing home quality and equity for all residents.The Centers for Medicare & Medicaid Services (CMS) grades nursing home performance in antipsychotic prescribing quarterly, publishing findings as a quality measure. While scores have improved since 2011, marked performance variation between facilities persists. To assess quality gap changes between best- and worst-performing deciles, we compared quarterly prescribing changes between these groups pre-pandemic (April 2011 to March 2020) and during the pandemic (April 2020 to March 2022). Antipsychotic quality measure scores, improving pre-pandemic, deteriorated during the pandemic. The pre-pandemic quality gap between the best- and worst-performing deciles narrowed as the worst-performing decile improved faster than the best-performing decile. During the pandemic, the quality gap widened as the worst-performing decile relapsed more than the best-performing decile (p < .0001). The pandemic disrupted quality performance gains and compounded disparities between facilities. A better understanding of the factors allowing high performers to weather pandemic stressors better than poor performers may reveal opportunities to improve nursing home quality and equity for all residents.
To investigate individuals’ implicit beliefs—underlying assumptions about the self and the world—the present study validated the Korean version of the implicit theory of work scale for ...undergraduates, exploring its role in career-related behaviors and affect. The study used two different samples of 560 and 340 undergraduates who participated in an online survey. The validity evidence of the scale was as follows: (1) The content of domains and items was appropriate for measuring implicit belief in work among Korean undergraduates; (2) a two-factor model with destiny belief and growth belief was confirmed by factor analysis; and (3) higher levels of destiny belief were related to higher levels of entity belief in intelligence and lower levels of incremental belief in intelligence, flexibility in career belief, and curiosity in career adaptability, whereas higher levels of growth belief showed the opposite patterns. The validated scale also showed the distinctive role of destiny and growth belief.
This study examines the growth of Medicare graduate medical education payments per resident full-time equivalent, variation in payment rates between hospitals, and potential savings from capping ...these payments.
The effects of ability performance goals, normative performance goals, and mastery goals on anxiety, interest, and performance were examined in a series of experiments. Challenging problem-solving ...tasks that would demonstrate the effects of each performance goal more clearly were designed. Groups of early adolescents (Study 1) and college students in Korea (Studies 2 and 3) participated in similar experiments to strengthen the generalizability of the findings. Across the 3 studies, students assigned to the ability-goal condition exhibited significantly higher anxiety and lower interest compared with those in the normative- and mastery-goal conditions, except that the anxiety between the 2 performance-goal conditions did not differ after experiencing failure in Study 3. The ability-goal students persisted for significantly less time than did those in the other 2 conditions (Study 1) and demonstrated significantly lower challenge appraisal and weaker reengagement intention compared with those in the normative-goal condition (Study 2). The effects of achievement goals on problem-solving performance varied across the studies.
Educational Impact and Implications Statement
This study suggests that students who pursue the goal of proving their ability to others while performing challenging problem-solving tasks are more vulnerable to anxiety and lack of interest compared with those whose goal is to perform better than others or to improve their competence. Although it was those students who strived to outperform others that received performance benefits, it was those who focused on learning new skills and developing their competence that demonstrated the highest level of persistence when engaging in a difficult problem-solving task. The results highlight the importance of providing a safe learning environment in which students can focus on learning and performing well without having to worry about how their ability will be evaluated.
Background: A range of economic and health policy incentives are leading to ongoing consolidation among payers, hospitals, and physician practices. Objective: To evaluate consolidation among ...radiologists' affiliated practices through 2023, analyze the impact of consolidation on such practices' specialty mix and size, and assess radiologists' new affiliations after prior practices cease. Methods: CMS data from 2014 to 2023 were used to identify all radiologists nationally along with their affiliated practices. Practices were categorized based on the specialty mix of all affiliated physicians as radiology-only or multispecialty; multispecialty practices were further categorized as radiology-majority, other-specialty-majority,or no-majority-specialty. Practices that ceased (i.e., became absent within CMS data) were identified. Temporal shifts were assessed, to infer consolidation patterns. Results: From 2014 to 2023, the number of Medicare-enrolled radiologists increased 17.3% from 30,723 to 36,024, while their number of affiliated practices decreased 14.7% from 5059 to 4313. The number of radiology-only, radiology-majority, other-specialty-majority, and no-majority practices changed by -31.8% (3104 to 2118), 10.8% (402 to 446), -5.7% (615 to 580), and 24.6% (938 to 1169), respectively. The number of practices with 1-2, 3-9, 10-24, 25-49, 50-99, and ≥100 radiologists changed by -18.7% (2233 to 1815), -34.4% (1406 to 923), -25.2% (910 to 681), 33.2% (352 to 469), 121.6% (125 to 277), and 348.5% (33 to 148). A total of 3494 practices ceased, including 2281 radiology-only practices. Among 3854 radiologists for whom their only affiliation was a ceased radiology-only practice, their subsequent-year affiliation was a radiology-only practice in 54.3% and a multispecialty practice type in the remaining instances. Conclusions: An overall decrease in the number of radiology practices and concurrent growth in the number of radiologists was mirrored by shifts from small toward large practices and from radiology-only toward multispecialty practices, consistent with ongoing practice consolidation. While determining causes of consolidation were beyond this study's scope, the shifts may relate to economic incentives and legislative changes favoring large multispecialty practices. Clinical Impact: Radiologists' continued consolidation into large multispecialty practices may facilitate subspecialization and greater negotiating power in payor contracting. Yet radiologists may prefer smaller and/or radiology-only practices for autonomy and influence on practice structure.Background: A range of economic and health policy incentives are leading to ongoing consolidation among payers, hospitals, and physician practices. Objective: To evaluate consolidation among radiologists' affiliated practices through 2023, analyze the impact of consolidation on such practices' specialty mix and size, and assess radiologists' new affiliations after prior practices cease. Methods: CMS data from 2014 to 2023 were used to identify all radiologists nationally along with their affiliated practices. Practices were categorized based on the specialty mix of all affiliated physicians as radiology-only or multispecialty; multispecialty practices were further categorized as radiology-majority, other-specialty-majority,or no-majority-specialty. Practices that ceased (i.e., became absent within CMS data) were identified. Temporal shifts were assessed, to infer consolidation patterns. Results: From 2014 to 2023, the number of Medicare-enrolled radiologists increased 17.3% from 30,723 to 36,024, while their number of affiliated practices decreased 14.7% from 5059 to 4313. The number of radiology-only, radiology-majority, other-specialty-majority, and no-majority practices changed by -31.8% (3104 to 2118), 10.8% (402 to 446), -5.7% (615 to 580), and 24.6% (938 to 1169), respectively. The number of practices with 1-2, 3-9, 10-24, 25-49, 50-99, and ≥100 radiologists changed by -18.7% (2233 to 1815), -34.4% (1406 to 923), -25.2% (910 to 681), 33.2% (352 to 469), 121.6% (125 to 277), and 348.5% (33 to 148). A total of 3494 practices ceased, including 2281 radiology-only practices. Among 3854 radiologists for whom their only affiliation was a ceased radiology-only practice, their subsequent-year affiliation was a radiology-only practice in 54.3% and a multispecialty practice type in the remaining instances. Conclusions: An overall decrease in the number of radiology practices and concurrent growth in the number of radiologists was mirrored by shifts from small toward large practices and from radiology-only toward multispecialty practices, consistent with ongoing practice consolidation. While determining causes of consolidation were beyond this study's scope, the shifts may relate to economic incentives and legislative changes favoring large multispecialty practices. Clinical Impact: Radiologists' continued consolidation into large multispecialty practices may facilitate subspecialization and greater negotiating power in payor contracting. Yet radiologists may prefer smaller and/or radiology-only practices for autonomy and influence on practice structure.
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