Population Health Management最新文献

The COVID-19 pandemic highlighted pediatric health care disparities and disrupted routine care, including social needs assessments. The American Academy of Pediatrics recommends universal screening for Social Determinants of Health (SDOH), yet implementation remains inconsistent in primary care settings. This quality improvement (QI) project aimed to implement a standardized, sustainable SDOH screening and referral process in pediatric primary care, hypothesizing that structured interventions would improve screening rates. This QI initiative was conducted from January to September 2023 across six practices within a large pediatric health system. Eligible patients (ages 0-19) included those attending their first well visit of the calendar year. The SMART aim targeted a 50% increase in SDOH screening compliance, from 28% at baseline to 42% over 9 months. Using the Consolidated Framework for Implementation Research and two Plan-Do-Study-Act cycles, the team addressed key implementation barriers and refined interventions. The primary measure was screening completion rate; the balancing measure was the number of refusals to screen. SDOH screening rates increased from 28% to 55%, with eligible patient volumes ranging from 2400 to 5500. All six practices demonstrated statistically significant improvements (P < 0.001). Positive screens ranged from 3.3% to 8% of patients screened. Screening refusals increased significantly (P < 0.001). Standardized SDOH screening, implemented through structured QI methods and stakeholder engagement, significantly improved screening rates in pediatric primary care. Future studies should assess referral effectiveness, clinical outcomes, cost-effectiveness, and strategies to mitigate patient discomfort and systemic barriers.

Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with cardiomyopathy (CM), associated with worse cardiovascular outcomes. This study aims to provide a comprehensive, national-level analysis of AF and CM-related mortality in the United States. The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was utilized, using death certificates from 1999 to 2024. The study included patients aged ≥15 years with CM and AF. Statistical analyses were conducted to calculate age-adjusted mortality rates (AAMRs) per 100,000 individuals and annual percent changes with 95% confidence intervals (CIs). Between 1999 and 2024, CM with concomitant AF accounted for 134,470 deaths among individuals aged 15 years or older. The overall AAMR rose from 1.5 per 100,000 in 1999 to 2.3 in 2024. From 1999 to 2016, the AAMR rose modestly (1.5-1.8), followed by a pronounced rise from 2016 to 2022 (1.8-2.5), and a relative decline by 2024 (2.5-2.3). Compared with 2019, mortality in 2020 demonstrated a 15% relative increase (incidence rate ratio = 1.15; 95% CI: 1.11-1.19). Males had disproportionately higher AAMRs compared to females. By race, the highest AAMRs were observed in non-Hispanic (NH) Black and White populations (1.8 each). Regionally, the West and Midwest exhibited the highest AAMRs (1.9 each). Urban-rural stratification revealed higher AAMRs among rural areas (2.2) when compared with urban (1.8) areas. Targeted public-health interventions and resource allocation to address this growing cardiovascular mortality burden, particularly in high-risk demographic groups, are needed.

Despite the well-established importance of health-related social needs in shaping patient outcomes, gaps remain in the literature examining these relationships at the individual level among patients undergoing cardiac surgery. This retrospective study used data from the 2016-2018 Nationwide Readmission Database to evaluate postoperative complications and readmissions in patients undergoing cardiac surgery (coronary artery bypass grafting, aortic surgery, valve surgery, or a combination) using individual-level social vulnerability clinically acknowledged using ICD-10 Z-codes. Six domains of ICD-10 Z-codes (employment, family, housing, psychosocial needs, socioeconomic status, dependence) were considered social vulnerabilities. Data were analyzed using stratification by social vulnerability status and multivariable logistic regression. Among the 846,837 included patients, dependence-related needs were the most documented domain. Patients with social vulnerability at any point were younger, had a longer length of stay, and had a higher prevalence of comorbid conditions, readmissions, and complications. For patients with social vulnerability, the odds ratio of complications was 1.12 (1.03-1.22), and the odds ratio of 90-day readmissions was 1.15 (1.03-1.27). Clinically acknowledged social vulnerability at any point was associated with higher odds of complications or readmissions after cardiac surgery. Z-codes may be useful for identifying nonmedical factors that can affect patient outcomes, but further standardization and assessment are needed.

Arthritis is a major health concern in middle-aged and older people. In females, estrogen decline after midlife may exacerbate abnormal adiposity and thereby heighten arthritis risk. Given China's large population, clarifying the relationship between fat mass and arthritis in middle-aged and older Chinese females is of great public-health importance. To explore the relationship between relative fat mass (RFM) and incident arthritis in middle-aged and older Chinese females. This population-based longitudinal study included 3874 females from the China Health and Retirement Longitudinal Study. Logistic regression and restricted cubic splines (RCS) evaluated the relationship between RFM and arthritis. Subgroup and interaction analyses explored potential heterogeneity across age groups and subgroups defined by chronic disease status. After full adjustment, females in the third (Q3 OR = 1.70, 95% CI: 1.24-2.33, P < 0.001) and fourth (Q4 OR = 1.67, 95% CI: 1.13-2.47, P = 0.010) RFM quartiles exhibited significantly higher odds of incident arthritis compared with those in the lowest quartile (Q1). Across the full study population and within the stratum of women below 60 years, RCS disclosed a statistically significant association between arthritis risk and RFM (P_overall < 0.05), with no indication of nonlinearity (P_nonlinear > 0.05). Subgroup analyses revealed no evidence of effect modification (P_interaction > 0.05). Higher levels of RFM are associated with increased risk of new-onset arthritis in middle-aged and older Chinese females, providing a crucial indicator for the early screening of female arthritis and indicating a potential for controlling arthritis incidence by targeted body fat management.

Early identification of cognitive changes is crucial for accessing timely interventions, implementing care planning, and optimizing quality of life for patients. Underdiagnosis of cognitive changes, particularly the subtle findings associated with mild cognitive impairment, is a significant issue in primary care. This pilot study compared provider's impression of a patient's cognitive status (provider gestalt) with a standardized screening tool (Mini-Cog^©) during the Medicare Annual Wellness Visit (AWV). During patient encounters, medical assistants administered the Mini-Cog in addition to the standard AWV. Clinicians were blinded to the Mini-Cog test result and provided an independent impression of cognitive status. Cohen's kappa was calculated to determine rates of agreement between providers' impression and Mini-Cog findings. Statistical analysis with Cohen's kappa indicated only fair agreement between the provider's impression of cognitive impairment and the Mini-Cog result (N = 76, k = 0.315). When discordance occurred between provider impression and Mini-Cog results, providers were more likely to document "no concern" for cognitive impairment in the presence of an abnormal Mini-Cog. Specifically, 19.7% of patients demonstrated a positive Mini-Cog when providers identified no cognitive concerns versus 5.3% of patients who demonstrated a negative Mini-Cog when providers documented concerns for cognitive impairment. Our study suggests under-identification of patients with cognitive impairment when provider impression alone is used to guide the diagnosis. Utilization of a standardized screening tool, such as the Mini-Cog, may minimize the risk of missing early signs of cognitive change.

Unpaid caregiving is associated with significant burdens, including financial strain, time constraints, diminished quality of life, and elevated stress levels. Despite these challenges, existing literature on disease burdens devotes limited attention to caregiver experiences. The aim of this scoping literature review was to identify instruments used to measure caregiver burden to better inform future studies of caregiver costs. This study included articles that estimated the costs or burdens associated with unpaid caregiving to patients in the United States and used a survey or cohort study design to conduct primary or secondary quantitative data analysis. Across the 46 articles abstracted, 27 unique survey instruments were identified; 23 (89%) instruments were validated, 12 (46%) were publicly available, and 14 (54%) were designed for or validated among caregivers. Among studies included in this review, 18 (39%) studies designed their own questionnaires to assess caregiver burden. This review additionally identified six nonsurvey data sources, such as medical claims data, used to estimate caregiver costs. The heterogeneity across measurement tools limits comparability across studies. Standardized, validated, and accessible instruments are essential for understanding caregiver burdens and advancing research to improve outcomes for patients and their caregivers.

Geographic and socioeconomic disparities in access to mental health care contribute to overall health inequity. Identifying scalable interventions that expand access to affordable and effective care remains a critical priority. This retrospective cohort study analyzed medical claims and census-level socioeconomic data from 742,658 individuals representing 90.9% of all US counties who were eligible for an employer-sponsored mental health benefit. Mental health service utilization was compared between individuals who accessed care through the benefit program and those who used the traditional health plan, across levels of socioeconomic disadvantage as measured by the area deprivation index. Program implementation was associated with a 36% relative increase in mental health care use overall compared to health plan utilization in the prior year. Following program implementation, care initiation increased equitably among program users, while disparities by area deprivation persisted among health plan users. Program users also had more equitable care retention and therapy duration across deprivation levels, whereas disparities increased among health plan users. Program initiation was positively associated with the number of employer-sponsored sessions, with a stronger association observed among individuals in high-deprivation areas. Lastly, program use was associated with significant reductions in anxiety and depression symptoms, with comparable treatment effects across deprivation levels. The benefit program was associated with more equitable care initiation and reduced socioeconomic disparities in engagement relative to traditional plans. Program users also experienced significant clinical improvements across deprivation levels. These findings highlight opportunities to reduce systemic barriers and promote equitable access to mental health care through scalable, real-world interventions.

Preventable readmissions represent a significant opportunity to improve quality and reduce healthcare costs, with approximately 26% of Medicare medicine readmissions considered preventable. However, evidence on the effectiveness of post-discharge interventions at scale remains mixed, and implementing evidence-based practices consistently across large, diverse health systems is a challenge. To address these concerns, the Mass General Brigham Population Health Services Organization (MGB PHSO) developed and implemented a novel, multidisciplinary, system-wide post-discharge intervention aimed at reducing 30-day readmissions within its Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO). It was hypothesized that standardizing delivery through a high-fidelity workflow would reduce readmissions. A standardized, multidisciplinary program was created involving: (1) a coordinator conducting chart review and obtaining records; (2) a pharmacist performing medication reconciliation; and (3) a registered nurse completing a post-discharge assessment. A prospective cohort study was conducted comparing the outcomes of patients at pilot intervention sites with those of a propensity-matched control group. The intervention cohort showed a directional reduction in 30-day readmission rates compared to the matched controls (13.5% vs. 16.3%, P = 0.07) but no significant difference in 30-day emergency department presentations. The intervention group also had a significantly higher rate of 14-day follow-up appointments (70.0% vs. 65.3%, P = 0.025). These findings support the effectiveness of a centralized, standardized post-discharge strategy for reducing readmissions within an ACO setting. This study demonstrates that structured, system-level interventions can improve care transitions and outcomes in value-based care models.

To determine whether pandemic-era Medicaid policies to increase postpartum coverage to 1 year were effective in preventing coverage loss into the second-year postpartum. The analytic sample included 7967 cases (N = 4632 in the pandemic era) from the 2019 and 2021-2024 Current Population Survey, Annual Social and Economic Supplement. On multivariable analysis of the entire sample, era was not associated with the type or continuity of insurance coverage. Among families living below 100% Federal Poverty Level, the relative risk of coverage gaps compared with continuous private coverage decreased by 58% (95% confidence interval: 19%, 79%, P = 0.010). Pandemic-era Medicaid policies appeared effective in preventing postpartum coverage loss in the second year after birth, especially among families living below the poverty line.