How Hypertension Guidelines Address Social Determinants of Health: A Systematic Scoping Review
Conclusion: Information about SDH is included in many hypertension guidelines, but few guidelines provide clear guidance for clinicians or health systems on how to identify and address social risk factors in the context of care delivery. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

Estimation of Utility Values for Computing Quality-adjusted Life Years Associated With Homelessness
Conclusions: The method developed in this study can be used to estimate QALYs in studies evaluating homelessness interventions, thereby establishing the societal value of these interventions and informing policy and budgetary decision-making. Future studies estimating the utility values associated with homelessness in the general population, as well as specific homeless groups, are required to provide more generalizable evidence. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

Assessing and Augmenting Predictive Models for Hospital Readmissions With Novel Variables in an Urban Safety-net Population
Background: The performance of existing predictive models of readmissions, such as the LACE, LACE+, and Epic models, is not established in urban safety-net populations. We assessed previously validated predictive models of readmission performance in a socially complex, urban safety-net population, and if augmentation with additional variables such as the Area Deprivation Index, mental health diagnoses, and housing access improves prediction. Through the addition of new variables, we introduce the LACE-social determinants of health (SDH) model. Methods: This retrospective cohort study included adult admissions fr...
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

First Year of Skilled Nursing Facility Value-based Purchasing Program Penalizes Facilities With Poorer Financial Performance
Conclusions: SNFs in the lowest profit margins are more likely to be penalized by the SNF-VBP, and these losses can exacerbate quality problems in SNFs with lower quality. Alternative approaches to measuring and rewarding SNFs under SNF-VBP or programs to assist struggling SNFs is warranted, particularly considering the coronavirus disease 2019 pandemic, which requires resources for prevention and management. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

Hospital-specific Template Matching for Benchmarking Performance in a Diverse Multihospital System
Conclusions: Hospital-specific template matching may be feasible for assessing hospital performance in the diverse VA health care system, but further refinements are needed to optimize the approach before operational use. Our findings are likely applicable to other large and diverse multihospital systems. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Applied Methods Source Type: research

Racial/Ethnic Differences in 30-Day Mortality for Heart Failure and Pneumonia in the Veterans Health Administration Using Claims-based, Clinical, and Social Risk-adjustment Variables
Conclusions: Compared with White Veterans, Black Veterans had lower mortality, and Hispanic Veterans had higher mortality for HF and pneumonia. The inclusion of clinical variables into risk-adjustment models impacted the magnitude of racial/ethnic differences in mortality following hospitalization. Future studies examining racial/ethnic disparities should consider including clinical variables for risk adjustment. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

Association of a Medicare Outpatient Payment Reform With Hospital-Primary Care Integration: Heterogeneity Across Markets and Physicians
Conclusions: Effects of Medicare’s site-based payments on hospital-primary care integration were concentrated among a small subset of physicians. Reforms to Medicare payment policy could influence integration among this group. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

Examining Patients’ Capacity to Use Patient Portals: Insights for Telehealth
Conclusions: Our findings highlight differences in patients’ capacity to use patient portals, which provide an initial understanding of factors that may influence the use of telehealth and offer important guidance in efforts to support patients’ telehealth use. Offering patients training tailored to the use of telehealth tools may be particularly beneficial. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Brief Report Source Type: research

Trends in Differences Across Subgroups of Adults in Preventive Services Utilization
Conclusion: While some differences have narrowed, large gaps in preventive service utilization across population subgroups remain. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

A Risk Prediction Model for Long-term Prescription Opioid Use
Conclusions: A model for the transition from opioid-naive status to long-term use had high discrimination and was well-calibrated. Given its high predictive performance, this model shows promise for future integration into PDMPs to aid clinicians in formulating opioid prescribing decisions at the point of care. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

An Interrupted Time-series Evaluation of the Association Between State Laws Mandating Prescriber Use of Prescription Drug Monitoring Programs and Discontinuation of Chronic Opioid Therapy in US Veterans
Conclusion: We did not find consistent evidence that state laws mandating provider PDMP use were associated with the discontinuation of chronic opioid therapy within the VA for the time period studied. (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Original Articles Source Type: research

Increased Utilization of Spinal Manipulation by Chiropractors to Tackle the Opioid Epidemic
No abstract available (Source: Medical Care)
Source: Medical Care - November 18, 2021 Category: Health Management Tags: Special Commentary Source Type: research

Heterogeneity of Treatment Effects Among Patients With Type 2 Diabetes and Elevated Body Mass Index in a Study Comparing Group Medical Visits Focused on Weight Management and Medication Intensification
Conclusion: This work represents a novel step toward targeting care approaches for patients to maximize benefit based on individual patient characteristics. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery
Conclusions: Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

Disparities in Audio-only Telemedicine Use Among Medicare Beneficiaries During the Coronavirus Disease 2019 Pandemic
Background: Under emergency coronavirus disease 2019 pandemic regulations, Medicare granted temporary payment parity with in-person visits for audio-only (telephone) telemedicine visits. This policy was designed to expand telemedicine to patients without camera-equipped devices and broadband internet. However, audio-only telemedicine use has been substantial. Objective: The aim of this study was to explore whether the rate of audio-only telemedicine during the pandemic is related to patient access to technology or provider behavior. Design: Cross-sectional analysis of the Summer and Fall 2020 Medicare Cur...
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients
Background: Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents’ preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers. Methods: We used administrative databases to establish a retrospective cohort study of home care recipients (2015–2017) in Ontario, Canada, where the predominant language is English. Residents’ preferred language (obtained fr...
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

Comparing Continuous and Binary Group-based Trajectory Modeling Using Statin Medication Adherence Data
Conclusions: Continuous and binary trajectory models are conceptually different measures of medication adherence. The choice between these approaches should be guided by study objectives and the role of medication adherence within the study—exposure, outcome, or confounder. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

Racial Disparities in Avoidable Hospitalizations in Traditional Medicare and Medicare Advantage
Conclusion: Our findings provide evidence of racial disparities in access to high-quality primary care, especially in MA. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

Patient-reported Outcomes Among Vulnerable Populations in the Medicare Bundled Payments for Care Improvement Initiative
Conclusions: As implemented by hospitals, BPCI Model 2 was not associated with adverse effects on patient-reported functional status among beneficiaries who may be vulnerable to reductions in care. Hospitals participating in heart failure, sepsis or pneumonia bundled payment episodes should focus on patient care experience while implementing changes in care delivery. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

Integrating Mental Health in Safety-net Primary Care: A Five-year Observational Study on Visits in a County Health System
Background: Beginning in 2010, Los Angeles County Departments of Health Services and Mental Health collaborated to increase access to effective mental health care. The Mental Health Integration Program (MHIP) embedded behavioral health specialists in primary care clinics to deliver brief, problem-focused treatments, and psychiatric consultation support for primary care-prescribed psychotropic medications. Objective: The aim was to compare primary care visits associated with psychiatric diagnoses before and after MHIP implementation. Methods: This retrospective cohort study (2009–2014) examined 62,94...
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Articles Source Type: research

Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care
Conclusions: Successfully adopted in all US allopathic medical schools, the 3T program will provide over 3800 attitudinally competent and mental health skills-qualified primary care faculty members. They would then be available to train nearly 100,000 medical students per year and 55,000 primary care residents to be as competent in basic mental health care as in medical care. This 3T program will begin to meet the needs each year for the millions of adults with major mental disorders that now are largely unrecognized and untreated. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Brief Report Source Type: research

Family Caregiver and Provider Perspectives on Inclusive Care: Aligning Needs and Expectations
Conclusions: Our findings suggest that expanding inclusive care could improve care quality and health outcomes of individuals with complex health care needs. Further, our findings bolster recent policy efforts at the federal and state levels to increase recognition of caregivers as key members of the health care team. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Patient-centered Care Source Type: research

Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later
Conclusions: Shadow coaching improved providers’ overall performance and communication immediately after being coached. Regularly planned shadow coaching “booster” sessions might maintain or even increase the improvement gained in patient experience scores, but research examining additional coaching and optimal implementation is needed. (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Original Article Source Type: research

Editorial on “Shadow Coaching Improves Patient Experience With Care, But Gains Erode Later” by Quigley et al
No abstract available (Source: Medical Care)
Source: Medical Care - October 21, 2021 Category: Health Management Tags: Editorial Source Type: research

Impact of Mental Health Insurance Legislation on Mental Health Treatment in a Longitudinal Sample of Adolescents
Conclusions: Prolonged exposure to comprehensive mental health laws across a person’s childhood and adolescence may reduce the demand for mental health visitations in adulthood, hence, reducing the burden on the payors and consumers. Further, as the exposure to the mental health law strengthened, the gap between at-risk subgroups was narrowed or eliminated at the highest policy exposure levels. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Original Articles Source Type: research

Hospital Length of Stay Prediction Methods: A Systematic Review
Conclusions: Methods to predict LOS are more and more elaborate and the assessment of their validity is increasingly rigorous. Reducing heterogeneity in how these methods are used and reported is key to transparency on their performance. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Original Articles Source Type: research

Predicting Unplanned Health Care Utilization and Cost: Comparing Patient-reported Outcomes Measurement Information System and Claims
Conclusion: One-time PROMIS measure data combined with claims data slightly improved predictive model performance compared with claims alone, but likely not to an extent that indicates improved practical utility for payers. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Original Articles Source Type: research

Continuity of Nursing Care in Home Health: Impact on Rehospitalization Among Older Adults With Dementia
Conclusions: Wide variations exist in continuity of nursing care to PWD. Consistency in nurse staff when providing HHC visits to PWD is critical for preventing rehospitalizations. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Original Articles Source Type: research

Comparing Web and Mail Protocols for Administering Hospital Consumer Assessment of Healthcare Providers and Systems Surveys
Conclusion: If web-based protocols are used for HCAHPS surveys, adjustments for a mode of data collection are needed to make results comparable. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Patient-centered Care Source Type: research

Racial Disparities in Preventable Adverse Events Attributed to Poor Care Coordination Reported in a National Study of Older US Adults
Conclusions: Black participants were significantly more likely to report a preventable adverse event attributable to poor care coordination than White participants, independent of demographic and clinical characteristics. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Patient-centered Care Source Type: research

Does Women’s Screening History Have Any Impact on Mammography Screening Attendance After Tailored Education?: A Systematic Review and Meta-analysis
Background: Many ethnic minority women have low attendance at breast cancer screening. Objectives: This brief report explores whether women’s screening histories impact mammography screening attendance after tailored education. Research Design: Systematic searches were conducted in 5 databases. Randomized controlled trials of educational interventions tailored to ethnic minority women that measured attendance at mammography screening were eligible for inclusion. Data extraction and risk of bias assessment were performed independently. Data were combined in a meta-analysis by using random effects mod...
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Brief Reports Source Type: research

Race, Ethnicity, Neighborhood Characteristics, and In-Hospital Coronavirus Disease-2019 Mortality
Conclusions: Neighborhood disadvantage independently predicted in-hospital COVID-19 mortality. Findings support calls to consider neighborhood measures for vaccine distribution and policies to mitigate disparities. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Brief Reports Source Type: research

Substance Use Disorders and Diabetes Care: Lessons From New York Health Homes
Conclusions: Individuals with both diabetes and SUD may benefit moderately more from care management than those without comorbid SUD. Individuals with both SUD and diabetes who are not enrolled in care management may be missing out on crucial diabetes care. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: From the States Source Type: research

The Significance of Depression for Short-term Readmission and Mortality After a Pneumonia Admission
Conclusion: Depression is an independent risk factor for 30-day mortality and readmission in persons who transfer from hospital care to home-based care. (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Original Articles Source Type: research

Psychosocial Determinants of Readmission After Surgery
Background: Quality of life and psychosocial determinants of health, such as health literacy and social support, are associated with increased health care utilization and adverse outcomes in medical populations. However, the effect on surgical health care utilization is less understood. Objective: We sought to examine the effect of patient-reported quality of life and psychosocial determinants of health on unplanned hospital readmissions in a surgical population. Research Design: This is a prospective cohort study using patient interviews at the time of hospital discharge from a Veterans Affairs hospital....
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Original Articles Source Type: research

Value of Nurse Practitioner Inpatient Hospital Staffing
The objective of this study was to determine whether the presence of more NPs produces better inpatient outcomes net of RN staffing. Research Design: This was a 2015–2016 cross-sectional data on 579 hospitals linked from: (1) RN4CAST-US nurse surveys; (2) Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient surveys; (3) surgical patient discharge abstracts; (4) Medicare Spending per Beneficiary (MSPB) reports; (5) American Hospital Association (AHA) Annual Survey. Hospitals were grouped according to their NP/beds ratios [ (Source: Medical Care)
Source: Medical Care - September 16, 2021 Category: Health Management Tags: Original Articles Source Type: research

Demographic Characteristics Driving Disparities in Receipt of Long-term Services and Supports in the Community Setting: Erratum
No abstract available (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Erratum Source Type: research

Will Improvements in Patient Experience With Care Impact Clinical and Quality of Care Outcomes?: A Systematic Review
Conclusions: Ratings of patient experience with care may influence clinical and quality outcomes of care. However, key inconsistencies between studies affirm that more research is needed to solidify this conclusion and investigate how patient experiences differentially relate to outcomes for various patient groups. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

Application of the Risk Stratification Index to Multilevel Models of All-condition 30-Day Mortality in Hospitalized Populations Over the Age of 65
Conclusion: RSI has superior accuracy and results in a significant shift in rankings compared with HCC in multilevel models of 30-day hospital mortality across all conditions. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

Nonprofit Hospital Community Benefits: Collaboration With Local Health Departments to Address the Drug Epidemic
Conclusions: Collaboration between NFPs and LHDs to address drug use was associated with a deceleration in drug-induced mortality. Policymakers can leverage community benefit regulation to encourage NFP-LHD collaboration in local health planning. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: From the States Source Type: research

Quality and Cost in Community Health Centers
Conclusion: Efforts toward improvement of primary health care quality delivered in CHCs need not involve greater cost. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

An Alternative Method of Public Reporting of Comparative Hospital Quality and Performance Data for Transparency Initiatives
Conclusion: Individualized peers that incorporate external complexity generate more nuanced comparators to evaluate quality. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

Implications of Electronic Consultations for Clinician Communication and Relationships: A Qualitative Study
Conclusions: Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

Changes in Opioid Prescribing Following the Implementation of State Policies Limiting Morphine Equivalent Daily Dose in a Commercially Insured Population
Conclusions: MEDD policies were associated with decreased use of any opioids relative to control states, but no change in high-dose prescribing was observed. While the overall policy environment in treatment states may have discouraged opioid prescribing, there was no evidence of MEDD policy impact, specifically. Further research is needed to understand the mechanisms through which MEDD policies may influence prescribing behavior. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

Hepatitis C Treatment by Nonspecialist Providers in the Direct-acting Antiviral Era
Conclusions: HCV treatment providers remain primarily gastroenterologists, even in the current simplified treatment era. Patients receiving treatment from general medicine or nonphysician providers had a similar likelihood of treatment completion, suggesting that removing barriers to the scale-up of treatment by nonspecialists may help close treatment gaps for hepatitis C. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Brief Reports Source Type: research

Changes in Type 2 Diabetes Medication Utilization and Costs in the United States, 2014–2019
The objective of this study was to describe national changes in utilization and associated costs of antidiabetic medications in the United States from 2014 to 2019, across different drug classes and insurance plans. Research Design and Methods: This retrospective, cross-sectional study examined administrative claims from a large national pharmacy benefits manager from January 1, 2014, to December 31, 2019. Patients aged 18 years and above enrolled in commercial, Medicare, or Medicaid health plans who filled ≥1 prescription claim for an antidiabetic medication(s) during the 6-year period were included. Utilization...
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Brief Reports Source Type: research

Cost-sharing With Medicaid Expansion in Michigan: Obligations and Propensity to Pay
Conclusions: Many payment obligations go uncollected, suggesting that in a system without the threat of disenrollment, the impacts of cost-sharing may be muted. Similarly, the ability of cost-sharing to defray the program’s budgetary impact may also be less than anticipated. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Brief Reports Source Type: research

Rates of Disenrollment From Medicare Advantage Plans Are Higher for Racial/Ethnic Minority Beneficiaries
The objective of this study was to investigate differences in rates of voluntary disenrollment from MA plans by race/ethnicity. Subjects: A total of 116,770,319 beneficiaries enrolled in 736 MA plans in 2015. Methods: Differences in rates of disenrollment across racial/ethnic groups [Asian or Pacific Islander (API), Black, Hispanic, and White] were summarized using 4 types of logistic regression models: adjusted and unadjusted models estimating overall differences and adjusted and unadjusted models estimating within-plan differences. Unadjusted overall models included only racial/ethnic group probabilities as...
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

The Relationship Between Unemployment and Health Insurance Coverage: Before and After the Affordable Care Act’s Coverage Expansions
Conclusions: Expanded access to coverage under the ACA could mitigate the adverse effects on insurance status and access to care historically linked to job loss. However, should the ACA be repealed, many households stand to lose their ability to turn to Medicaid or subsidized nongroup coverage as safety-net resources to offset the burdens of job loss. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research

The Affordable Care Act and Health Care Access and Utilization Among White, Asian, and Latino Immigrants in California
Conclusions: Insurance coverage increased significantly for these 3 immigrant groups after the ACA. While Latino immigrants had the largest gain in insurance coverage, the proportion of Latino immigrants with insurance remained the lowest among the 3 immigrant racial/ethnic groups. (Source: Medical Care)
Source: Medical Care - September 1, 2021 Category: Health Management Tags: Original Articles Source Type: research