Population Health Management最新文献

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.

Uncontrolled hypertension remains a leading modifiable risk factor for cardiovascular disease. Numerous quality improvement initiatives have aimed to address health care challenges associated with uncontrolled hypertension, many of which have been organized around the American Medical Association Measure Accurately, Act Rapidly, and Partner with Patients (AMA MAP) hypertension quality improvement framework. This paper describes a multifaceted hypertension quality improvement program initiated within a large university-based internal medicine clinic. Key interventions targeted at "Measure Accurately" included staff retraining on blood pressure (BP) measurement, implementation of BP recheck protocols, and a structured home BP monitor validation process. To combat clinical inertia and "Act Rapidly," the clinic introduced a visual BP alert system, promoted clinical pharmacist comanagement, and distributed monthly provider performance reports. Lastly, to "Partner with Patients," patient engagement was enhanced via targeted outreach, a care team approach focused on holistic patient care, and increased patient education. One year after implementation, the clinic's hypertension control rate had increased from 66% to 72% (P = 0.047), while control rates across other system clinics remained unchanged. During this time, 343 patients had staff visits for BP checks, 287 patients had validated home BP monitors documented in their electronic health record, 302 patients engaged with a clinical pharmacist for hypertension comanagement, and 575 received individualized outreach from the care manager to increase engagement. This multifaceted quality improvement program improved patient care and increased hypertension control rates. These interventions have demonstrated sustainability and have been adopted by other primary care clinics in this system.

Hidradenitis suppurativa (HS) is a painful, progressive, and disfiguring rare inflammatory skin condition with significant diagnostic delays due to limited awareness. This study aims to develop and validate digital algorithms using integrated electronic medical records (ieMR) to identify undiagnosed HS patients. A test cohort of 121 HS cases (patients who visited a dermatologist-led HS clinic and received treatment) and 187,106 controls (emergency department patients) were identified from patients attending a Queensland tertiary hospital from 2018 to 2022. Using demographics, structured ieMR data and free-text flags, we developed one logistic regression and two random forest algorithms (with and without class weighting) to predict HS. A clinical chart audit of 200 randomly selected patients helped refine the best-performing algorithm, which was then validated using data from another tertiary hospital. Logistic regression performed best at a threshold of 0.4 (sensitivity: 0.66 [0.58, 0.74], positive predictive value [PPV]: 0.71 [0.64, 0.80]). Strong predictors included dermatology clinic visits, free-text diagnostic notes, lesion location terms, antibiotic and isotretinoin use, and elevated inflammatory markers. Internal validation showed high agreement, and the refined model improved sensitivity to 0.89 (0.83, 0.94) and PPV to 0.87 (0.81, 0.92). This model performed relatively well in the validation cohort, with sensitivity and specificity (at threshold 0.4) both >0.70 and a PPV of 0.45, supporting clinical utility. Validated digital algorithms incorporating key diagnostic indicators may help identify undiagnosed HS patients, reducing diagnostic delays and improving prevalence assessment.

Cognitive decline and late-life depression are intertwined public health challenges for aging populations globally. To inform effective prevention, the current study investigated the dynamic temporal associations between multidimensional cognitive functions and depressive symptoms. Using four waves of longitudinal data (2013-2020) from a large panel study of older adults, the current study employed an integrated framework combining optimized dynamic time warping, cross-lagged panel models, and network analysis to model complex, lagged relationships. Results provided strong empirical support for the "cognition-first" hypothesis, with declines in several cognitive domains-notably temporal orientation, calculation, and immediate recall-acting as significant upstream predictors of subsequent depressive symptoms. A modest but significant protective feedback effect from positive affect to cognitive maintenance was also identified, while negative affect showed no significant predictive role sample of older adults who were cognitively and emotionally healthy at baseline. These findings offer preliminary empirical support for a strategic shift in population health management from reactive treatment toward proactive prevention. Based on these results, the current study discusses a conceptual framework for integrating cognitive screening into primary care to identify at-risk older adults, an approach that warrants further investigation and validation. This proactive approach could enable timely, low-cost interventions aimed at promoting positive affect and cognitive resilience, offering a potentially cost-effective strategy to mitigate the long-term burden of mental illness and advance the goals of healthy aging.

Medicine has historically been conceptualized as not simply an occupation but rather as a profession, one that entails both substantial privileges as well as significant responsibilities. In this article, the majority of whose authors are cardiologists serving on the American College of Cardiology Ethics Committee, we observe the evolution of professional values in Western medicine along a continuum shaped by both intrinsic and extrinsic forces with respect to the physician and the medical profession. Though a historically reactive process, we argue for a more proactive and anticipatory approach moving forward that reframes professionalism and what it means to be part of a profession, aiming to reconcile cross-generational professional values in the interest of advancing health and human flourishing. Rather than rejecting the power and privilege of our profession, thus leaving a vacuum to be filled by administrators and politicians, we should reclaim and repurpose it to provide better care and promote better outcomes.

The opioid epidemic in the United States has led to a sharp rise in overdose deaths over the past two decades. Although some progress was observed prior to the coronavirus disease 2019 pandemic, opioid-related mortality has increased again in recent years, underscoring the need to re-examine national trends. A retrospective analysis of opioid overdose mortality among US adults aged 25 years and older from 1999 to 2024 was performed using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiological Research (CDC WONDER) Multiple Cause-of-Death database. Opioid-related deaths were identified using the International Classification of Diseases, Tenth Revision, codes T40.0-T40.4 and T40.6. Mortality rates were calculated by year, sex, age, race/ethnicity, and US census region. Temporal trends were evaluated using Joinpoint regression to estimate annual percent changes. A total of 806,765 opioid overdose deaths occurred during the study period. The age-adjusted mortality rate (AAMR) increased from 4.41 to 22.84 per 100,000. Men consistently had higher AAMRs than women (men: 20.64; women: 9.52). Racial disparities were evident, with the highest rates observed among non-Hispanic American Indian/Alaska Native (21.79), non-Hispanic White (18.07), and non-Hispanic Black (15.97) populations. Adults aged 35-44 years had the highest crude mortality rates (20.52). Among US regions, the Northeast had the highest AAMR (18.09), followed by the Midwest (15.69), South (14.74), and West (13.09). These findings confirm that opioid overdose remains a major public health issue, with persistent demographic and regional disparities necessitating targeted strategies to reduce mortality.