Population Health Management最新文献

Recombinant zoster vaccine (RZV) was recommended in 2020 in the US for adults aged ≥50 years. This retrospective study used cross-sectional data from 2020 National Health Interview Survey respondents aged ≥50 years. Sample weights were applied to allow results to be representative of the non-institutionalized US population. Associations between respondent characteristics and coverage were explored using logistic regression. An estimated 14.1% of US adults aged ≥50 years had received ≥1 dose of RZV by 2020. Coverage varied by race and ethnicity (6.3% Hispanic, 6.9% Black/African American, 13.7% Asian, 16.6% White), education (6.9% for grade 1-11 to 24.1% with master's degrees), household income (8.8% for <$35,000 to 18.8% for ≥$100,000), age (7.3%, 14.6%, 19.9%, and 18.1% for ages 50-59, 60-64, 65-74, and ≥75 years, respectively), health insurance (2.2% without, 14.8% with), recency of last health visit (1.8% if >3 years prior to 15.1% if <1 year), and receipt of influenza vaccine in the past year (3.9% without, 21.1% with) (all P < 0.001). In multivariable analysis, factors associated with lower RZV coverage included Black/African American race, Hispanic ethnicity, age 50-59 years, lower household income, less recent last health visit, and no influenza vaccination. In conclusion, only 1-in-7 non-institutionalized Americans aged ≥50 years reported RZV coverage by 2020, with significant disparities among subgroups defined by race and ethnicity, age, and levels of educational attainment, income, and insurance. These results highlight an opportunity to improve herpes zoster protection through increased vaccination, pursued in a more equitable manner. [Figure: see text].

Complex care curricula (or "interprofessional student hotspotting") are experiential, longitudinal programs based on complex care practice models where health professions students engage patients with complex health and social needs through personalized, hands-on interventions. Prior studies report mixed impacts of complex care curricula and practice models on hospital readmissions and health care costs, but evaluation of patient-driven goals and outcomes has been sparse. The objective of this study was to characterize the goals of individuals with complex health and social needs that engage with complex care curricula and the associated interventions and barriers reported by interprofessional student teams. Capstone projects of 30 student teams spanning a 5-year period (2015-2020) were analyzed via directed content analysis to identify patient goals, team interventions, and barriers. Thematic analysis revealed that the most common patient goals and team interventions focused on enhancing self-efficacy in managing health (72% and 59%, respectively) and health care system navigation (50% and 69%). Identified barriers fell into 3 major categories: barriers encountered with the health system (28%), related to the individual (66%), and arising in teamwork (50%). Over the course of each curricular cycle, students graduated with an appreciation of the importance of collaborative care for complex patients. The longitudinal impact of this analysis emphasizes patients as key stakeholders in the development of complex care curricula. By deepening our understanding of patient goals, intervention trends, and barriers-we allow for enhanced programming that prepares health professionals for practice, optimizes collaboration on interprofessional health teams, and ensures better outcomes for patients.

In breast cancer, clinicians add data on social support to patient electronic health records (EHRs) often in free text notes, but those data may be challenging to use for population health initiatives or research purposes. We evaluated the EHR-Support score designed to summarize need for social support using data from the EHR. This study included 996 women from the Pathways study, a Kaiser Permanente Northern California cohort of women diagnosed in 2005-2013 with breast cancer. This unique data resource included both EHR data and questionnaire data on patient-reported social support. Using unstructured EHR data and natural language processing, we developed 11 concept groups (items) characterizing social support. We also used structured data to create two additional concept groups. EHR-Support scores reflecting the lack of social support were generated three ways: counting the number of negative concept groups (count score), using item response theory (IRT), and converting counts to the IRT metric (converted count scores). The count scores were only associated with two of six patient-reported measures (r's: -0.004 to -0.073). The IRT score (r's: -0.038 to -0.179) and converted count score (r's: -0.032 to -0.195) were associated with five of six patient-reported measures, indicating more need for support was associated with less patient-reported social support. The EHR-Support score is a valid and feasible measure of social support that can be used for health services research and managing population health. The converted count score may provide the best balance of validity, precision from IRT and feasibility.

Patients with co-occurring medical and psychiatric conditions often face fragmented care and prolonged hospitalizations in traditional medical units (MUs). Integrated medical-psychiatry units (MPUs) offer a model of concurrent care that may better meet the needs of these patients, but limited data exist on which patient populations benefit most. This study retrospectively compared outcomes for patients with psychiatric conditions discharged from an MPU versus traditional MUs within a single academic medical center between 2019 and 2023. Subgroups included patients presenting with suicidal ideation (SI) or toxic overdose (OD). Primary outcomes were length of stay (LOS) and discharge to the community. MPU patients were younger, more likely to be on Medicaid, and had significantly higher rates of psychotic, mood, substance use, and cognitive disorders (all P < 0.001). Despite this higher psychiatric complexity, MPU patients had shorter LOS and higher rates of discharge to home than their counterparts on general MUs, even after adjusting for demographic and clinical differences. Among patients with SI, those on the MPU had an average LOS of 5.5 days compared to 6.7 days in traditional units (P = 0.006). These findings highlight the effectiveness of MPUs in managing complex, high-need patients and support the broader implementation of integrated, interdisciplinary care models to improve hospital outcomes and care transitions for vulnerable populations.

Bulk messaging is an important population health tool used to engage patients in preventive care and chronic disease management, yet little is known about optimal formatting of the communication. One factor to consider is whether the signatory of the patient-facing communication is the patient's own Primary Care Provider (PCP) or a generic care team signature. In this quasi-randomized, non-blinded study we compared identical generic bulk outreach messages directed toward patients with an upcoming appointment and invited them to self-schedule a Medicare Annual wellness visit prior to their scheduled PCP appointment. Twenty-eight PCPs (1582 patients) were assigned to the PCP signature group, and 22 PCPs (1289 patients) to the care team signature group. The primary outcome was patient engagement, defined as a reply to the outreach message. Demographic, utilization, and rates of reading the bulk outreach message were similar between groups. Reply rates were significantly higher in the PCP signature group compared with the care team signature group (39.2% vs. 25.2%; odds ratio 1.86; P < 0.001). These findings suggest that using a patient's own PCP signature in bulk outreach can meaningfully increase engagement, likely leveraging the trust inherent in established PCP-patient relationships. These results may inform health system leaders and population health teams seeking to optimize digital outreach strategies.

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.

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.

This study explored a large segment of Medicare claims data to evaluate the association between Accountable Care Organization (ACO) attribution and 30-day all-cause hospital readmissions. ACOs deliver value-based care to attributed patient populations, aiming to enhance care coordination and transitional care outcomes. Initiatives such as the Medicare Shared Savings Program (MSSP) incentivize health care systems to reduce readmissions and the total cost of care. The study included all Medicare inpatient discharges across 50 US states from January 1, 2022, to December 1, 2024. The primary measure of interest was 30-day all-cause readmissions. Hospitalizations for ACO-attributed beneficiaries (readmitted vs. not readmitted) were compared with hospitalizations for non-ACO-attributed beneficiaries. Subgroup and sensitivity analyses were conducted to explore ACO readmission performance with cohorts of beneficiaries with higher levels of clinical complexity and single or multiple hospital admissions. MSSP ACO beneficiaries had a 6% lower rate of 30-day all-cause readmissions. When restricting the cohorts to beneficiaries with higher levels of clinical complexity, MSSP ACO participants had significantly lower readmission rates. Sensitivity analyses adjusting for unequal sample sizes, differences in clinical complexity, and excess zeros (statistical overinflation) indicated that despite the positive effect of multiple hospitalizations, assignment to an ACO was significantly associated with lower readmission risk. The ACO care delivery model is a high-performing care coordination model that exemplifies best practices in addressing transitional care challenges, providing actionable insights for other health care organizations seeking to advance their transitional care strategies within value-based programs.

Community health workers (CHW) play a unique role as trusted frontline public health workers who connect underserved populations with health and social services. In addition, CHWs have local insights on underserved patients and families, which can help to reduce information gaps and enhance the capacity of health care systems to understand health-related social needs. However, prior reviews have included studies of varying quality, which makes it difficult to assess rigorous evidence from randomized control trial (RCT) studies. Also, many CHW intervention studies do not clearly specify in which organizational setting a CHW is employed. This scoping review of US studies published in the peer-reviewed literature from 2000 to 2023 focuses on RCT studies of CHW interventions by type of organization. A total of 39 studies met all inclusion criteria. Most RCT studies were conducted in health care systems and among safety-net providers, including community health centers. However, only a handful of rigorous RCT studies of CHW interventions were conducted in public health agencies or payer settings (managed care organizations). Overall, most RCT studies of CHW interventions found consistent evidence of improved outcomes. Health care organizations can enhance their efforts to address resource gaps by hiring CHWs or partnering with organizations that employ CHWs. Finally, future RCT studies on CHWs employed by health plans (payers) or public health agencies are needed to bolster the growing body of rigorous evidence that CHWs are highly effective in improving patient outcomes across multiple organizational settings.