Medical Care Research and Review最新文献

Contemporary practice guidelines recommend nonpharmacologic therapies instead of prescription opioids as first-line treatment for many pain types, including acute low back pain (aLBP). This serial cross-sectional study describes trends in the annual prevalence of physical therapy (PT), chiropractic care, gabapentinoids, and prescription opioid receipt among Medicare beneficiaries diagnosed with aLBP from 2016 to 2019, overall and within key demographic, clinical, and geographic subgroups. Overall, changes in PT (5.5%-6.7%), chiropractic care (11.0%-11.7%), and gabapentinoid (9.6%-8.9%) receipt were limited, whereas prescription opioid use substantially decreased (26.2%-17.8%). Prescription opioid receipt was higher among individuals under age 65, American Indian/Alaskan Native, non-Hispanic Black/African American, and Hispanic individuals, individuals with opioid use disorder, and in Southern states, while the use of nonpharmacologic pain therapies remained low among these subgroups. It is essential to promote equitable access to multimodal and guideline-recommended approaches for aLBP management including nonpharmacologic therapies.

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.

We sought to understand stakeholder experience with telehealth services, through interviews with patients, providers, and health plans, to inform Medicaid policy after the COVID-19 public health emergency. Our primary aim was to examine whether and how such telehealth policies affect equitable care delivery and to uncover any remaining policy gaps. Applying the Framework for Digital Health Equity our study identified digital determinants that operate at the individual, interpersonal, community and societal levels. Across respondents, telehealth expansion was viewed as overwhelmingly positive and noted as a significant contributor to increased access among marginalized, minoritized, and rural Medicaid participants in this study. Despite these strengths, patients and health care providers identified several challenges and recommendations.

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.

This cross-sectional study examines shifts in health industry entry and sector choice among women, racially minoritized workers, and immigrants during the pandemic era. Using data from the Annual Social and Economic Supplement of the Current Population Survey (2018-2023), we compare entrant characteristics before and during the pandemic era, focusing on demographic composition and sector choice. Results show minimal shifts by gender, race, or education but highlight a rise in entrants from outside the labor force, particularly among White women and racially minoritized men. There were changes in sector choice: ambulatory care saw the greatest increase in racially minoritized entrants, with small increases for hospitals and a decrease for long-term care. Despite these sector-specific shifts, overall opportunities for minoritized workers did not expand, nor did workforce diversity significantly improve. These findings underscore the need for research that examines how policies outside the workplace shape worker behavior, particularly among marginalized groups.

While community-based palliative care (CBPC) programs have been expanding, there remain important obstacles to widespread use. Since provider perspectives on CBPC remain underexplored, we conducted a scoping review to summarize provider perspectives regarding barriers and facilitators to implementation of adult CBPC in the United States. We systematically searched OVID, MEDLINE, and CINAHL for peer-reviewed qualitative research published from January 1, 2010 to January 9, 2024, then used PRISM framework synthesis to organize themes into provider, organization, and external environment levels. Thirty-four articles were included. At the provider level, barriers included misperceptions of palliative care (PC) by referring providers and poor communication, while facilitators included multidisciplinary teams and referring provider education. At the organizational level, time constraints were barriers, while leadership buy-in and co-located clinics were facilitators. At the external environment level, limited PC workforce and inadequate reimbursement were barriers. Our findings suggest that efforts aimed at scaling CBPC must address factors at the provider, organizational, and policy levels.

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.

To analyze the determinants and effects of hospital entry, we compare entrants' quality of care to incumbent hospitals. Using national hospital-level patient mortality measures from July 2005 to June 2019 for Medicare patients with common medical conditions (heart attack, heart failure, and pneumonia), we establish that entrant hospitals experience 0.27 to 0.76 fewer deaths per 100 patients than incumbent hospitals in the same markets. We further show that new hospitals enter markets where they can provide higher quality care than incumbent hospitals.

The number of hospitals screening patients for health-related social needs (HRSNs) has increased substantially in recent years, yet little is known about the extent to which hospitals invest in programs or strategies aimed at addressing identified needs. Using data from the 2022 American Hospital Association (AHA) Annual Survey for 2,468 non-federal general medical and surgical hospitals, this study explored screening rates and related interventions for eight HRSNs: housing, food insecurity, utilities, interpersonal violence, transportation, employment or income, education, and social isolation. Sample hospitals screened for an average of 6.1 HRSNs and had programs or strategies for an average of 5.4 HRSNs. Hospitals that screened their patients for HRSNs were significantly more likely to invest in interventions aimed at addressing these needs. Serving patients more holistically by addressing both medical and social needs has the potential to improve health outcomes and ultimately reduce health disparities.

This study used three national data sources to estimate the size and distribution of Community health workers (CHWS) in the United States. CHWs were identified in the National Plan and Provider Enumeration System (NPPES; 2022), Bureau of Labor Statistics (BLS) data (2021), and American Community Survey (ACS; 2020). The rate of CHWs per 100,000 people was calculated and compared across states. Then, the study assessed if the rate of CHWS per the population varied in states with or without CHW certification or reimbursement in a series of one-way analyses of variance (ANOVAs). Nationally, the rate of CHWs per 100,000 people in NPPES is 7.44, 18.37 in the BLS, and 35.44 in the ACS. No significant differences in the mean number of CHWs per 100,0000 people in states with or without certification and/or reimbursement was found. Further exploration of available data sources is needed to provide new insights and potential solutions to employ, fund, and sustain the CHW workforce.