Medical Care Research and Review最新文献

This study estimates the effect of nursing home closure on occupancy, net profit margin, and operating margin of nearby nursing homes. We use national nursing home data from 2009 to 2019 from Medicare cost reports, Medicare Provider of Services (POS), and LTCfocus.org data. Using the Callaway and Sant'Anna difference-in-differences model, we compare the changes in occupancy, net profit margin, and operating margin between incumbent nursing homes in markets with any closure and nursing homes in markets without a closure, overall, and across rurality. Our findings suggest that nursing home closure improves the occupancy rates of remaining nursing homes in the same market in rural areas but there is little evidence of effects in metropolitan and micropolitan areas. Nursing home regulators and local officials should consider the long-term care market heterogeneity when considering interventions targeted at nursing home closure.

This article estimates differences and difference-in-differences in patient experiences for Veterans Health Administration (VA) compared to non-VA patients in 2017, when there was concern about the health quality of VA hospitals, and in 2021, the second year of the COVID-19 pandemic, both overall, and for specific patient groups. We used data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In 2017, HCAHPS performance was somewhat better for non-VA than for VA hospitals, with Care Transition being the only measure for which VA hospitals performed better on average. By 2021, HCAHPS performance was better for VA than for non-VA hospitals for all but two measures (Quietness and Discharge Information), for which there were no differences from non-VA hospitals. In 2017, the VA provided worse experiences than non-VA hospitals for Black and poor-health patients; in 2021, VA hospitals outperformed non-VA hospitals for these, and all patient subgroups examined.

This study assessed the distribution of Covid Provider Relief Funds (PRFs) to 3,886 private and public general acute care hospitals during 2020-2022. Marginal effects from two-part regression were analyzed. More than 13% of study hospitals did not receive PRFs. Some targeted groups of hospitals, that is, safety-net hospitals and high-impact hospitals (those with high COVID-19 admissions), were the most likely to receive PRFs. Hospitals providing the most uncompensated care, and facilities serving counties with high concentrations of Black or Hispanic populations, were less likely to receive PRFs. Among facilities receiving subsidies, rural, high-impact, safety-net, and financially vulnerable hospitals received more PRFs in relation to their total revenues. Those serving impoverished communities received a larger proportion of PRFs relative to their total revenues, while those in areas with a high concentration of Hispanics received a smaller proportionate subsidy.

Post-acute care users in Medicare Advantage (MA) plans may seek coverage changes if facing issues with plan benefits. In 2019, the Centers for Medicare and Medicaid Services extended the deadline to disenroll from an MA plan from February 14 to March 31 and, for the first time, permitted beneficiaries to switch to a different MA plan instead of traditional Medicare. Using 2016-2019 Medicare administrative data, we implemented a difference-in-differences approach to evaluate the impact of this policy on disenrollment from a plan within 1 month of initiating skilled nursing facility or home health services. When MA disenrollment rules became more flexible, overall rates of exiting MA plans did not change. Switching to a different MA plan increased after the policy change, but this outcome was so rare that this increase did not affect overall rates of exiting MA plans.

This systematic review investigates disparities in COVID-19 outcomes (infections, hospitalizations, and deaths) between urban and rural populations in the United States. Of the 3,091 articles screened, 55 were selected. Most studies (n = 43) conducted national analyses, using 2020 data, with some extending into 2021. Findings show urban areas had higher COVID-19 cases and hospitalizations in 2020, while rural areas saw increased cases in 2021 and mixed hospitalization results. Urban areas also had higher mortality rates in 2020, with rural rates rising in 2021 and 2022. Most studies did not explore reasons for urban/rural differences. The few that did found that vulnerable groups, including racially and ethnically minoritized populations, older adults, and those with comorbidities and lower socioeconomic status and vaccination rates, experienced exacerbated disparities in rural regions. COVID-19 outcomes varied over time and by area due to population density, healthcare infrastructure, and socioeconomic factors. Tailored interventions are essential for health equity and effective policies.

Little is known about online medical record (OMR) use among caregivers, including changes in OMR use through the COVID-19 pandemic. This study compares OMR use among caregivers and non-caregivers before and during the COVID-19 pandemic, identifies reasons for non-use, and examines the association between caregiving status and characteristics with OMR use. Secondary data analysis of the nationally representative Health Information National Trends Survey data from 2018 to 2022 (n = 14,034). Caregivers were more likely to use the OMR post-COVID (51.8%) compared with pre-COVID (44.7%). Caregiving was significantly associated with increased likelihood of OMR use post-COVID (odds ratio = 1.67), but not pre-COVID. The increased use of OMR among caregivers during COVID-19 highlights the potential of OMRs as a support tool for caregivers' health and well-being. Interventions and policies to improve OMR engagement must address persisting disparities across demographic groups and encourage caregivers' OMR use to support their role and enhance their personal health management.

We examined peer-reviewed publications analyzing data from the English GP Patient Survey (GPPS), U.S. National Health Interview Survey (NHIS), and California Health Interview Survey (CHIS) to explore how the health of sexual minority populations varies across settings and subgroups. We searched for English language articles published 2011-2022, screening abstracts (n = 112), reviewing full text (n = 97), and extracting data (n = 85). We conducted a content analysis to identify patterns across settings for sexual minority people compared with heterosexual counterparts and each other. Across all settings, sexual minority adults had poorer health care access, worse health outcomes and patient experiences, more detrimental health behaviors, and greater health care services utilization (reflecting risk awareness and need). When subgroup data were reported, differences were greater among women, except for HIV and related cancers, which were most prevalent among sexual minority men. Sexual minority people generally reported significantly worse health access, outcomes, and behaviors in all three settings.

Proposals to reduce the cost of health care services and improve the quality of care often involve ambitious expectations for the role of primary care clinics (PCCs). We systematically reviewed the literature to identify interventions PCCs could undertake to reduce avoidable emergency department visits and ambulatory care-sensitive admissions. Database searches resulted in only seven studies that met the inclusion criteria for this review. Very few studies identified interventions that primary care physicians could undertake to reduce total cost of care, possibly because relatively few PCCs are held responsible for total cost of care. Evidence-based interventions to reduce ACS admissions and ED use included case-management models, clinical decision-support tools, & care plans integrated into patients' electronic medical records. The interventions highlighted a heightened role for PCCs in care coordination and access to care that could lead to patients actively engaging in care management and consulting PCCs before seeking urgent care.

Individuals dually enrolled in Medicare and Medicaid often experience fragmented care that fails to meet their health care needs and is unduly expensive due to a lack of coordination between Medicare and Medicaid programs. Washington state's Health Home Managed Fee-For-Service demonstration, part of the Financial Alignment Initiative, sought to improve care and reduce costs for high-cost, high-risk dual enrollees through care coordination. Using Medicare and Medicaid administrative claims data from 2016 to 2019, we evaluate the impact of the Washington demonstration on health care utilization using a modified regression discontinuity design. We find that for relatively healthy enrollees on the margin of eligibility for the demonstration, enrollment in the demonstration modestly reduced emergency department visits, ambulatory care visits, and some types of home and community-based service (HCBS) use and reduced nursing facility stays for older enrollees, but did not impact inpatient or skilled nursing facility admissions. Addressing the fragmentation of coverage, care, and financing for dual enrollees remains an important policy and research priority.

Empowering beneficiaries to choose a health plan that meets their health needs during the transition to Medicaid managed care is critical to promote informed decision-making. This study uses North Carolina's transition under the 1115 waiver to examine the role of the state, health plans, and providers in informing beneficiaries about the transition. We reviewed policy documents and interviewed 43 individuals representing provider practices and 10 representing the State Department of Health and Human Services and health plans between December 2020 and September 2021. Interviewees from the state described strategies to encourage beneficiaries to select a health plan. Participating practices shared that their patients were unaware or confused about the transition. These concerns led practices to engage beneficiaries and contract with all health plans to ensure continuity of care, contributing to administrative burdens. While the state made significant efforts to engage beneficiaries, the interaction between beneficiaries and providers was still critical.