Population Health Management最新文献

Physician workload is known to impact provider well-being and individual patient encounters, but less is understood about how provider availability affects broader community health outcomes. Primary care physicians (PCPs) often serve as de facto mental health providers, particularly in underserved communities. This study evaluated whether PCP and mental health provider workload, measured by provider-to-resident ratios, predict population-level physical and mental health outcomes. County-level data from the 2024 Robert Wood Johnson Foundation County Health Rankings dataset (N = 3142 counties) were analyzed using two path analysis models; such models are used to estimate both direct and indirect relationships among multiple predictors and outcomes simultaneously. Predictor variables included provider ratios, percent uninsured (mediator), and self-reported physically and mentally unhealthy days (outcomes). Higher PCP workload was significantly associated with greater numbers of poor physical and mental health days. Mental health provider ratios were not directly associated with either outcome. Indirect effects through the percent uninsured were also significant, particularly for physical health outcomes. These findings suggest that PCPs play a disproportionate role in shaping both mental and physical health at the community level. The analysis supports the conclusion that addressing provider shortages and improving insurance coverage can enhance health outcomes, particularly when efforts are integrated into collaborative care models that distribute workload across providers and align treatment approaches with the diverse psychosocial and medical needs of the populations they serve.

The increasing demand for skilled professionals in population health management (PHM) has highlighted the need for a clear understanding of workforce requirements and competencies. This scoping review aims to address this gap by identifying key roles, responsibilities, and competencies necessary for effective PHM implementation. The review was conducted using PubMed and Google Scholar. Articles focusing on PHM workforce requirements, job titles, roles, responsibilities, and competencies were included. Data were extracted and synthesized to address the research questions. A total of 30 records were reviewed, revealing a diverse range of PHM leadership roles, the importance of interdisciplinary teams, and the need for strategic workforce planning. Five core competency domains were identified: Population Health Knowledge and Expertise, Leadership, Data Literacy and Analytics, Business and Operations, and InterpersonalCommunication Skills. Effective PHM implementation requires a diverse, skilled workforce with clearly defined roles and competencies. These findings provide a framework for workforce development and highlight the need for standardized competency-based training in PHM.

Personal health factors and direct and indirect costs of obesity affect employers and employees. This research aimed to understand perceptions of obesity management and anti-obesity medications (AOMs) among employers and employees. In 2022, people with obesity and employers completed cross-sectional surveys about perceptions of obesity and its management, including AOMs. Data were analyzed with descriptive statistics. Data from 461 employed people with obesity (EwO) and 51 employer representatives (ER) were analyzed. Both EwO and ER acknowledged the impact of obesity on future health problems (88.3%; 100.0%) and perceived obesity as a disease (60.5%; 80.4%) to varied degrees. Both groups perceived an incremental value in combining self-directed lifestyle changes and AOMs (57.5%; 66.7%) and perceived healthcare provider-guided lifestyle change alongside AOMs as the most effective approach for maintaining long-term weight reduction (56.4%; 66.6%). More than two-thirds (68.6%) of ER expressed willingness to revisit their AOM coverage decisions, though cost of medication coverage (72.5%) and affordability of medications for employees (68.7%) were identified as barriers. ER believed that data showing reductions in premiums and claims at their organizations (78.4%) would be helpful in supporting the coverage of AOMs. While EwO and ER were receptive toward AOMs, organization-level barriers existed with AOM coverage. Evidence demonstrating the benefits of evidence-based obesity care, direct/indirect cost reductions, and the impact of obesity may address barriers to AOM coverage and improve obesity care and outcomes of their workforces.

The Affordable Care Act (ACA) expanded health care access in the United States. This study examines the long-term impact of the ACA on private health insurance enrollment using National Health Interview Survey (NHIS) data. A repeated cross-sectional study using NHIS data from 2015 to 2022 was analyzed. Given the repeal of the ACA's individual mandate in 2019, stratified analyses compared Marketplace enrollment before (2015, 2018) and after (2019, 2022) the repeal. The study included US adults aged 26-64 years. Unadjusted enrollment rates were compared across age, sex, race/ethnicity, social determinants of health (SDOH), chronic conditions, body mass index, and smoking. Multivariable logistic regression assessed enrollment trends and associated factors. Marketplace enrollment increased by 1.4 percentage points post-mandate (P < 0.001), with no significant change pre-mandate (0.5-point decline, P = 0.235). Some subgroups (ages 26-39, Midwest, West) saw declines pre-mandate, while many experienced increased enrollments post-mandate. After adjustment, individuals in 2022 had 27% higher odds of enrollment than in 2019 (adjusted odds ratio [aOR] = 1.27, 95% confidence interval [CI] = 1.13-1.43, P < 0.001), whereas no significant change occurred between 2015 and 2018 (aOR = 1.02, 95% CI = 0.89-1.16, P = 0.818). Age, racial minority status, and unfavorable SDOH were associated with higher post-mandate enrollment odds. Marketplace enrollment grew post-mandate, particularly among vulnerable populations. While the repeal of the individual mandate may have contributed, other policy changes-expanded enrollment windows, increased subsidies, enhanced outreach, and streamlined applications-likely played a role, particularly in response to COVID-19.

Hypertension control remains challenging for many primary care patients. The goal of this study was to implement an evidence-based team approach to improve hypertension control, self-reported health distress, and self-efficacy in adult patients with hypertension at a large academic family medicine practice. The 5-year intervention included team-based medication therapy management, patient-centered behavioral counseling, and home blood pressure monitoring. Pre- and post-intervention blood pressure and patient surveys were analyzed using paired t-tests. The authors observed significant decreases in systolic blood pressure (148.4 vs. 135.6, P = 0.001) and self-reported health distress over the enrollment period in participants who completed the study. The multidisciplinary intervention was associated with reduced systolic blood pressure and health distress in patients who enrolled and completed the program. A multidisciplinary blood pressure monitoring program can be implemented by providers referring patients with uncontrolled hypertension after pharmacologic interventions.

Virtual urgent care (VUC) and emergency department at home (ED at home) are two emerging interventions that may help address avoidable health care costs driven by inadequate access to primary care. This study evaluates the integration of VUC and ED at home as a combined mobile integrated care program, into a value-based primary care model that serves Medicaid and dual-eligible populations. Use of embedded VUC and ED at home among individuals with claim-identified physical health needs was associated with a statistically significant 27% reduction in inpatient admissions (P = 0.05), a 61% reduction in readmission (P = 0.04), and a 240% increase in engagement with primary care and care coordination (P < 0.001). Use of these services was also associated with a total cost of care decrease of $550 per member per month (P = 0.07). Findings suggest that virtual and home-based acute care services may be a promising lever for value-based payment models to enhance engagement and realize goals of improved cost and outcomes among populations with complex medical and social needs.

The aim was to compare clinical outcomes for older adults with diabetes who received telehealth (TH) as an adjunct to in-person care (F2F) compared with those who received in-person only care (F2F). Systematic literature search was performed using the following databases: Ovid MEDLINE, Embase, Scopus, Web of Science, Cochrane, CINAHL, and ClinicalTrials.gov to include studies involving TH care for older adults with diabetes. Two authors independently reviewed the full text of shortlisted articles. A total of four studies that met the eligibility criteria were included. One study showed slight worsening in glycemic control in the TH group, but the remaining three showed improvement or no difference between the two groups. This review shows that TH modality, when utilized as an adjunct to F2F care, has comparability to F2F alone, with similar or better glycemic control for older adults with type II diabetes, especially those residing in rural communities, those older than age 75, and those with multiple comorbidities who had multiple clinical encounters.

Despite ample evidence supporting their efficacy in atherosclerotic cardiovascular disease (ASCVD) management, statin-prescribing and low-density lipoprotein cholesterol (LDL-C) measurement are underused, especially for vulnerable populations. This study explores the impact of a Best Practices Learning Collaborative to improve the management of patients with ASCVD for secondary prevention. Conducted with the guidance of a subject-matter expert advisory committee, the ASCVD Collaborative convened a geographically diverse group of health care organizations (HCOs) over a 12-month implementation period to set goals, develop and implement interventions, collect and track quality performance measures, and share best practices. Interventions included provider/staff education, clinical decision support tools, care coordination, patient education and awareness, and the treatment of very high-risk patients. HCOs tracked three measures for patients with established ASCVD: any statin prescribed (stratified by sex and race/ethnicity), high-intensity statin prescribed, and LDL-C control (<70 mg/dL). After a 12-month implementation period, HCOs demonstrated improvement in one or more measures. The Collaborative model was shown to be an effective means for achieving improvement in the management of ASCVD, laying the groundwork for future more rigorous studies to identify the most impactful interventions.